HomeMy WebLinkAboutBuilding Permit Application 02/19/2019 04 :58 AM PST TO: 17724621578 FROM: 5617631006 Page: 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Date: Permit Numb r_
KLCLIVLD
FEB 19 2019
Building Permit Application sT. Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 L/
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOBATION:
Address: ¢SS
Legal Description:
Property Tax ID#: Lot No.�(J
Site Plan Name: Block No. .�
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be errtorme under t —checkispermit a appy:
HVAC 11 Gas Tank ❑Gas Piping ri Shutters a Windows/Doors
11 Electric 19 Plumbing Sprinklers 1:1 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 6 0. 15 Utilities:nSewer Septic Building Height-
OWNER/LESSEE:
eight:0WNER/LESSEE: CONTRACTOR:
Name w Name: %0 V1
Address: C n P3 h Company:
City: e- State: Address: Ak 13!
Zip Code:- '34 Fax: City: P S L State:
a
Phone No. Zip Code: w��i06 Fax:
E-Mail: Phone No. 77.2'_?7_�— 0010
Fill in fee simple Title Holder on next page(if different E-Mail: ' b 1, UVr �JG�
from the Owner listed above) State or County License: S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
02/19/2019 04 :58 AM PST TO: 17724621578 FROM:5617631006 Page: 1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGN ER/ENG I NEER:
NFORMATION: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 1 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 orstcl6rdingour Notice of Commencement. ,t
Signature of Owner/L 795ee/Contractor as Agent for Owner Signature of Contractor/ cense Vder A
STATE OF FLORIDA a STATE OF FLORIDA - , /
COUNTY OF COUNTY OF LFA t
The fgrg3gng instrup:en w;�ackno V)edged,before me The:�� forg ng instru entwas ackn 1 dged,before me
this t( .s�a//y��of f(it(�i� 20by thisday G�,C7�G 20�t%by
Name of person m*ng statement Name of person ing statement
Personally Known i/sOR Produced Identification Personally Known !/ R Produced Identification
Type of Identifi, ion Type of Identificatio
Produced Produced
( gnature of Notary Public ' 'ori da l (Si re of Notary Pub ic- da) R 1 emoga
t�0�MIWon#GG101442 Gomm)sbn#GG10144
Commission No. $ (Stili$: 4,2621 Commission No. z x`= (Seifes May 4 2021
"1QV0F';�,�'' Bonded thio Aaron Notary �h,,;'i R'.� Bonded thio Aaron Nota
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ---
COMPLETED
Rev.8/2/17