HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. 121 Permit Number:AC\6 'k_Q S5(3
RECEIVED
- FEB 2 7 2019
Building Permit Applicatihn �uc;eCouneysE�EPPT1ilii
Planning and Development Services .—
Building and Code Regulation Division
2300 Virginia.Avenue,Fort Pierce FL 34982 r/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential . f
PERMIT APPLICATION FOR: `
PROPQSED INP O EMENT I ATI'N.
Address: 8 k-J o
Legal Description:
PropertyTax ID#: Lot No.
Site Plan Name: h Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRI�PTfON CaF WflRK
3 a 2
CONSTRUCTICr1'V I. FORM TION:
'Aaditi 0-fi5l work to be pe orme ,�,;,un er t isperms#—c ec .a that apply: °�•
_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: $ �� (Q D Utilities: _Sewer _Septic Building,Height:
OWN 1R/LW&M. CONTRA IllQ
Named c"�- Name:
Address:"8 Ll.Z . 'I�l.e�� �i �A Company:`' vCP
City: .�e��- `:`�r...�:c c�P' Stater Address`: d OJc( SL_j �Zip Code:Code: c3 /�' Fax: City: Stater
Phone No. S� �f �,� 5' �3Q Zip Code: -�>Lt 781 Fax:
E-Mail: Phone No a(3 SS CV
Fill in fee simple Title Holder on next page(if different E-Mail /� {� a.� ►�: °l�� q�nnC'1J '
from the Owner listed above) State or County License .3b--I- d
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required..
SUP'L AMENTIMS LIEN LAW NFORMAN]IO'N:
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 anyrestrictions 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.
I - - y J
Signature of Owner/Lessee/Contractor as Agent for Owner XignaY6re of Contractor icense Holder
STATE OF FLORIDA STATE OF FLORVDA ,
COUNTY OF SV \-V c�� COUNTY OF SS k, \.-,Z-60k,
The forgoing instrum nt was acknowledge before me The forgoing instrum nt.was acknowledged before me
this?�! day of 201 -by this Q-�L day of ,201 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced �LrD
(Signature of Notary blic-State of Florida Ng (Signature of Nota�, -
GNE p NMAftIE GNEGG 022023 G 022023
Commission No. �. " '; ,, r ��yM1S �t16,202pommission No. _ COMM1�16,2020
M Pti�Es'U publtcUnder�' a� ;a; EXPIRES:o publ'icUnderwltare
oe dThNpotaN '�rEOFFOP'` sondedThNNta<Y
e
REVIEWS FRONT G SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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