HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T��� Permit Number:\C;,(3
r
RECEIVED
s. .
Building Permit Applicati n
JAN 2 9 2019
Planning and Development Services r _J
ST. Lucie 41ity I?@Cti?I 1f19
Building and Code Regulation Division v
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 5
PRZERO EJ 11 11 MA E Q"I I IN LOCAffil IO'
Address: 350 X5001) J'0 81942�7
Legal Description: 2. 3 2 3 "-5-G 00c' / —000 —�
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET'AII.ED Df�SCRI�PTION l� WQRK.
Itn'WITIRUCTIO~ I'Ni=ORMATIO
Additional work to be pertormed under,t is,permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric - _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 000 -.CIO Utilities: —Sewer _Septic Building Height:
OWNS ER L15-5 EE. CONTRACTOR:
Name Name:
Address: Company: �G G
City: State: Z Address:
Zip Code: �T Fax: City: Stater
Phone No. Z' /(9�— Zip Code: Fax:
E-Mail: Phone No Z 7-3—_-5 s5 3
Fill in fee simple Title Holder on next page(if different E-Mail ewe�C ^�-LG •�
from the Owner listed above) State or County License�J'L�D•] � `
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPLEME TAI.CC}NSl' MMTIQ
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 thepermit 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 insp n. If you intend to obtain financing, consult with I r or an attorney before
commenci ork& r cordin ur Notice of Commencement.
Sign ture f O ne /Lessee Contractor as Agent for Owner atu of ntractor/License Holder
STATE O FLORIDA STA FLORIDA
COUNTY OF COUNTY OF 5�' •L �1��
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
thisa!\ day of ��� ,20 V by this Q�day of 26!�_ by
�J �n�
7::5 e-,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced- Produced V �2
(Signature of Notary Public-State of (Signature of NotaN Public-State of Florida )
pEpNNA MARIE GIVENS i
#GG 022023 ` l .. z, 1Y�NS
Commission No.� 'a4.� MYCOM1080ber1G 202o Commission No. _ COMM 022oza
t*s �CPIRES:GPublic Undenvriless
ed?hru Nc1ary a `a 5 EXPIRES:December 16,202D I
:1
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DATE
RECEIVED
DATE
COMPLETED
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