HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:a''� � Permit Number:
-- RECEIVED
Building Permit Applicati n FEB 0 4 2019
Planning and Development Services ST.k,kcle 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: To Select from dropbox, click arrow at the end of line
-PRQPOSED,IMPROVEMENT L'bcATi.OMi
Address: Lo O {' vj'- -+ tri
Legal Descriptlon:LO( � td i� l — 10 Q � K, t A(o tat I op lC
Property Tax ID#:._.I J � �+ "— d L LOS `ObO-- O Lot No.
Site Plan Name: Block No.
Project Name: f
Setbacks Front Back: Right Side: Left Side:
DETAILED DE:SCRI:PTlON t9F V1/C)RK: � ,�, - l5- i''� '=
IMP06 �tasS) .
CONSTRUCTION"INFORMlATlON:. .
itiona workto, e e orme un er t is permit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers F]Generator F]Roof Roof pitch
Total Sq.Ft of Construction: �_ Sq. Ft.of First Floor:
Cost of Construction:$ � Utilities:F-1 Sewer F]Septic Building Height:
OWNER/LESSEE-
Name eTMiyi (5hn6 b I
Name: LOV_11�e_sco-Tycees (-LC
Address: Company: Y
City: State: Address: '4>0 1`3x9 et
Zip Code: Fax: City: ar 0_06 0 State:_
Phone No. Zip Code: a Fax:
E-Mail: Phone No.:7"?-7 1.453 IM, I
Fill in fee simple Title Holder on next page(if different E-Mail:5eaS LC .-
from the Owner listed above) State or County License:�`.1 C_S �i 41 „L_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT1.0 LIEN LAW INFORMATIQN:` 4:
/ Applicable,:. .. . MORTGAGE COMPANY: Not A x-
DESIGNER/ENGINEER: Not ppiicable
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 resu .n your paying twice for
improvements toy r ropeiA otice of Commencement must be recorde an poste the jobsite
before the first in ect on. If u in end to obtain financing,vonsu th len r o an a me before
commencing war or r cor 'n ou Notice of Commencement.
. y L/ V
Signature of 0 er/Lessee/Contractor a Age t for Owner Signature of Con r ctor/License der
STATE OFF ORiDA STATE OF FL iDA
COUNTY 0 i eca COUNTY OF �t c
g g' :0 g ,fp g w owledget,before me
this or oaa to rues acknowledge ed J�bI. y re me this'Lgod oda of�—C t _,,,,,,_ 20I by
' —!}
PA
Name of person making statement Name of person making statement
Personally Known�C _OR Produced ident' c tion Personally Known ).e_OR Produced Identificat'
Type of Identification Type of Identification
Produced Produced
( ignature of N ary Fub!'icS a e of F! Signature of ata u I'c-S f r'
J$tY FyQ Notary Public Stat Ida gY pyo Notary Public$tate of F rid
Commission o �t Commissio a
� 'I�F2iccaboni � �caboni
My Commission FF 981647 y:_ ort My commission FF 981647
*".ice Expires 0512812020 Y�'at ri4� Expires 05/2812020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17