HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: PermitNumber:
RECEIVED
Building Permit Application FEB 14 2019
Planning and Development Services ST. Lucie
Building and Code Regulation Division
23W 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
ENT L Q
Address:
-M I L -
Legal Description: La]4L UArCV ��kJ-e-!S FCL LO+ (L+()
Property Tax ID#: o-5 b t E54 fib 6 Lot No. 14-D
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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-C9,N, -sT, ,RVCTTIQN INFQRIVfATIONr
Additional worK to ne nerformed under this permit-cneCK all tilu apply:
IDHVAC Gas Tank Flas Piping "Shutters 17 Windows/Doors
11 Electric Plumbing Sprinklers E]Generator1:1 Roof Roof pitch
Total Sq.R of Construction: So.Ft.of First Floor:
Cost of Construction:$ 9—1Q 5 6 0 Utilities: Sewer EJ Septic Building Height:
OWNERbkT
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Ps, ...............
Name 10MV1 a-- DM S4 Name:-Sb Pen ej ri!�
Address: .010s-,P, IC14- Company:
City: C*'A q 11CAk StateT-� Address: 1011
Zip Code:4in R Q Fax: city: W Ymb State-
MnLffi
Phone No. Zip Code: Fax:
E-Mail: PhoneNo- �g&
Fill in fee simple Title Holder on next page If different E-Mail:S-M%\C1 67r"l
from the Owner listed above) State or County License:_ 1-75-7
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C`ONSTRUCTiOM11 LIEN LAW iN` ORMATION. Y
x
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 x recording our Notice of Commencement.
Signature o Owner/Lessee/Contractor as Agent for Owner Signature of Contra r/License HoTder
STATE OF FLORIDA STATE OF FLOR D�_AI
COUNTY OF l r a ccl a IQ � COUNTY OF I rna,so n a-1,y`G(it—
The forgoing instrument was acknowledged before me The foZgoing instrument was acknowledged before me
this. o day of.]E9J2nAQ:6::nk `,2011 by this l4 day ofT f_nA00 .26A by
LW
Name of person aking statement Name of perso making statement
Personally Known V OR Produced Identification Personally Known " OR Produced Identification
Type of Identification Type of Identification
Produced Produced
{Signa re of N ry Public-kate of F! ida} {Signature of N&ah Public-State of F ida}
os1,%:°" KELLY L.MONEYHA �o'�RY ;moo KELLY L.MONEYHAN
Commission No. " al L mmission No. (jyl g MISSION t FF 943559
* * Y COMmi.,SION t FF 94
EXPIRES,July 26,24 9 EXPIRES:July 26,2019
Bonded Thru Budget Notary Se Vices '9rEaFF�oe`� BondedThru Budget Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE T_
COMPLETED
Rev.8/2/17