HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
_ Building Permit Applicatio JAN 2 8 2019
Planning and Development Services ST. Lucie County,Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 . Commercial Residential
PERMIT APPLICATION FOR:
PROP SED INPROVMENT L• Al-IC} WlIIIIIIIIIIIII
Address: A6 R Edo,] n �.1
Legal Description:
Property Tax ID#: Ll 2Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Df hLED DESCRI"TION OF WOR
1 .� �
5�ce 9-0+� ce. r-�; n
l voocd Gance, e K O-P :Qr
ck n r( h-� i n q FcJk%,�► ►-)
CONSTR�l1C ION fNFOR4M�ATION: JY
Additional work to be pertormed un er t is permit-cneCK a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ D _ D� Utilities: —Sewer —Septic Building Height:
WIT13700 NMI 1 : CONTRA OR:
Name ef1 CQke-ecli
/1 Name:.
Address: X r w ave-- Company:
City: fiorce State:_ Address:
Zip Code: 3L4 LI�0 Fax: City: State:
Phone No. O - LQq I X i Zip Code: Fax:
E-Mail: I aShcA.!DcA0_-N(PCpa-)c6L54 )1t;1_ Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S PPLEMENTAL CONST ,k1CTION L EN LAW INFO'RMATlO
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms'and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF V COUNTY OF
The for ing instru ent was acknowledge efore me The forgoing instrument was acknowledged before me
thisday of 20�by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi n Type of Identification
Produced VL Produced
J h A A 21 L
(Signature of Notary Pu ic-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. KAREN IELSEN Commission No. (Seal)
State of Florida-Notary Public
=* *= Commissi n #GG 207484
11 OF R°��` My Commission Expires
REVIEWS "� iz. 1.OR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER R 111/ REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.8/2/17