HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: oti��1� Permit Number:
"" ; ; ,` � J' RECEIVED
_ Building Permit Applicatio
FEB 2 5 2019
Planning and Development Services ST, 1-1� ie9Nny, PgPiiiltlf�9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
A WO>ED 1 i° M EME LOC/ATI , /
Address: O � J 0- 0 L !o e ve� o .L'h
Legal Description:
Property Tax ID#: Vb 01" Sy d�`�5'(56d' 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DECK+IPTIONF WORK.
co �TRLICT�•NtN�FaR� AT o�
itiona wor to a pe orm un„ er-t, is permit,-,c,ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 0a v Utilities: _Sewer _Septic Building Height:
OWNER/LCA-SSE : CONTRA 'OR:
Name A.:V c. b S'bl A,4 4 A C Name: - C. L
Address: 111\6�- Si�J.�Pi1 acs 51'— Company:
City: ' . R State:_fL Address:
Zip Code: 3y"1'S'3 Fax: City: &, 5 'Z4b�aw _vl State:
Phone No. Zip Code: 3 4& 3 Fax:
E-Mail: Phone No. IS
in fee simple Title Holder on next page(if different E-Mail ���
from the Owner listed.above) State or County License EC l3 0 O 69 - D_
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CaNNFORMATION:
DESIGNER/ENGINEER`: _Not Applicable MORTGAGE COMPANY: _Not'Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FTE 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 permif 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 a4fulI coneurrenSY,review: room.additions,
accessory structures,swimming pools,fences,walls,signs,screen'roornss-and accessory uses fo 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 recordinUpur Notice of C
omoepcement.
Signature of Owner/Lessee/Contractor as AgentL6 wn r i ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 6k•
The forgoing instru e t was acknowledge before me The forgoing instru ent was acknowledged before me
this'Z65 day of � ,201 by thisa'o> day of F .20NI by
Ge.4.t a, "ONg,.\JSG, *" G-_m'C'e � G %,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi tion Type of Identification
Produced I_ fl Produced 1,fl ►—
(Signature of Notary Public-State of Florida) (Signature of Nota P date of) dIWIEGNENS
:24 ate
6
IIpMNR1EGNENS MYCOMMISSI N#GG 022023
Commission No.r!sG07. li+ • MISSION#GG 022023 ommission No. EXPIRES:�r16,2020
2020 ded Thru No c Underwriters
EXPIRE
Decep c Underwrite -
Notary
REVIEWS FRONT ING SUPERVISOR PLANS VEGETATION SEA TURTLE; MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.