HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: 2 - 2 Permit Number: l Vr _ Sot
21-
RECEIVED
uilding Permit Applicatio FEBF2 0 2019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentialy
PERMIT APPLICATION FOR: vj,A6Z
PRQPOSED I ' P ' OUEMENT LOCATI:O
Address: 2ig::2 w S
Legal Description:
Property Tax ID#: vOv ' &re Lot No.
Site Plan Name: �%� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ED
DETAIi r �► •
' DESCRdPTION WORK:
1,4 4�� l C G
R�UCT10 FNFOR TION:
Additonalwor tobepertormed unclerthIS permit–, check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
V--Electric &41ru mbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Constructio,. Sq. Ft.of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
O NER/LESS 1 : CONTR
Name L/ Name:
Address_: ��r,�� Lr�Z'JAg �D Company:,,'.
City: 0/e/ r�,L �c'rrzT State: rL Address: PH X5� /,30-2
Zip Code: r7, l9 ZZ Fax: City: iCyl Pr State:
Phone No. . '77Z rj 7� t7l& 4/�+2 Zip Code: Fax:
E-Mail: Phone No 777 5
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License d l S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
N . LE MA I R MTLAIL CONST CTIO LIEN LAW I ft�RMATION:
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 prilhe jobsite
before the first inspection. If you intend to obtain financing, consultlender o an attor e " efore
commencjrrg wor, or ppcoriJyour Notice of Commencement.
Signature of Owner ess e/C ntractor as Agent for Owner Signature of Contractor/Licens older
STATE OF FLORID . STATE OF FLORIDA
COUNTY OF •�Li ,l COUNTY OF '
Ther oing instru s acknowledge before me The f r oing instru as acknowledge before me
this day of 20J4 by this day of 20a by
Name of person making statement. / Name of person making'slitement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification v
Type of Identification Type of Identific '
Produced LProduced
(Signat re of Nota (Signa ure of No ary ub ic-State of agalIFIJI
7KAREN S. NIELSEN
;o`" gf Flo 'otary Public \\aYp�,, KAREN S. NIELSEN
Commission No. __ ;.o� ammissibn#'c?G 207484 Commission No. .o ;State oEl}la-Notary Public
y Comrrlission Expires =. += Commission#GG 207484
Ff�� 12 2022 My Commission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17