HomeMy WebLinkAboutBuilding Permit Application • • i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: •-
RECEIVED
Building Permit Application FEB 112019
Planning and Development Services
Building and Code Regulation Division ST,Lucie GountY,Permitting
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 rM
PROPOSED IMPROVEMENT LOCATION.-
Address:
OCATION:
Address:_ (eW3 SE=Q9sby--%
Legal Description: L_L:2�WOC�"C U V._O I'1( l:. l 2,_ 6L K � -0Q_ L-�
Property Tax lD#: 2JQ 1 _(p1 ``!" QL 1 f,�'QQQ"`2_ Lot No.
Site Plan Name: t_ Block No. )l,00
Project Name: Y11(��1
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF.WORK:
S rv� � nc=�S 13 OQef` r 5
CONSTRUCTION`INFORMATION:
Adclitionalwork to •(e'performedunder tispermit—checka y:
HVAC (=.1 Gas Tank FIGas Piping M_Shutters Windows/Doors
nElectric F-1 Plumbing Sprinklers u Generator 0 Roof .Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ (�00 Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: 'CONTRACTOR'-
Name
CONTRACTOR:Name QrNJNamc
1i rr�
� �
Address: E -7 4woa.-t h'- CompaA I V-) 1t V O
City: ei�'"`f wYn'_.. State: C.... Address:�'119 K; )
Zip Code: 3g9St Fax: City:PSS State-�ft--
Phone No. Zip Code: (0 Fax:
E-Mail: Phone No. —140
Fill in fee simple Title Holder on next page(if different E-Mail: E
from the Owner listed above) State or County License: �2
If value of construction is$2500 or more,a RECORDED notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: v W Name:
Addre s: W St Address:
City: V ,S State: City: State:
Zip: Pone' fi —t 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/Lic nse Holder
STATE OF FLORIDA STATE OF FLORIDA {^p {
COUNTY OF �' COUNTY OF
The f oing instr m nt was cknowledg before me The fo oing instr met as ack to ledge efore me
this day of�i 20 by this day of � 20by
Name of per ,making statement Name of p rs n making statement
Personally Known )OR Produced Identification Personally Known.---/ OR Produced Identification
Type of Identificatio Type of Identificati n
Produced Produced
,of N Ju
lAigale of Notary Publi S e of Florida) ign a of Notary Pubii - to of Florida)
Commissn Commiss' S !)
o " ��Nata1'9"Po>s►t�Srate of Florida �`�^►y0V'►r"�
Liza D Mayfield .4 ^Oe Nota Public State of Florida
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REVIEWS FRONT ZO l SUPERVISOR PLANS MANGROVE
MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17