HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 179 .
Date: 0? �� �7 Permit Numbe • r " C �
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R E C EEO 1 1 val'E wD
Building Permit Application FEB 12 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 S LlJ ie C nty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED WROVEMENT LOCATIQN:.
Address: I DU6 S. eec n _ r. L4 a 6 3F-' p
Legal Description: 1 St LUC,I e, 61k e) 1 11 R a n� t' La I rD-M
in Ver esV i n C Com m ori e ntiex\�s �b 33 fro-a n3
Property Tax ID#: g511 - ,-501 DM3-Dc o -S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION`OF WORK
.. . , ..,
eXis��. .. °shl r�cl<< �cbaF end 1+n�S SII rem taVN) rA� Ie p oli�
CONSTRUCTION INFORMATION.
Mclitional work to be nertormed under this permit-check all appy:
❑HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
11Electric ❑Plumbing OSprinklers Generator Roof 3 Roof pitch
Total Sq. Ft of Construction: B (00 S . Ft.of First Floor:
Cost of Construction:$ S/l�� Utilities. Sewer E]Septic Building Height:
OWN ER/LESSEE CONTRACTOR:.
Name rnark, +- t i rrt of IG Q Name:
Address: ams Company:
City: I—e_nSen` 'E'er State:d2 Address:: Q0 0)QX 003
(
Zip Code: `�j`I 15 r) Fax: City: Y0. M CI State:-F—L
Phone No.DMA.
r7-1 30 Zip Code: 3g0tq 1 Fax:
E-Mail: DMA. r)G� Q (!omOCO , ne, Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: SVa1BK1ne v-\ L MOC e •COQ
from the Owner listed above) State or County License: S 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONST_kUCTIO:N LIEN LAW INFORMATION; ,
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 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 Sign�of Contractor/License Holder
STATE OF FLO�IAALuo1 a COUNTY OF Isjy LSTATE OF FLORIDA I)6 e-
COUNTY OF }
The fgrgoing instru�pg�nt�wa�s acknowledged before me The_fpLgoing instrumepwas acknowledg before me
this day of F-'CXJ CLY_l 2 by thi day of FP_ Ua✓'q 20L by
►'YY�ir k �,1 ch�,� err,� e C t s e�
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known u.-' OR Produced Identification
Type of Identification Type of Identification
Produced i ZN n Se_� Produced
n,
(Sign ure of Not ry Pu3ME1.
(Sign ure of No ry ublic- tate of FI rida
State of Florida el P0' -.7. Ma'PdIyn
oary Pugql��cc S e of Florida
Commission No. 9 Commission No. KYdin FF 230979/2019 v My Commisslon FF 230979
0 Exires o8/28/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17