HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��1� Permit Number:
�T
r "
RECEIVED
_ BUilding Permit Application MAR 01 -2019
Planning and Development Services
ST. weie Cauntpj P&ini>ting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)4624578 Commercial Residential
PERMIT APPLICATION FOR: 1 ��
PR4POSED IN'PRtJVEME TOCATI(�}� :
Address: b b I SwPf .C x. ..17 �`l7j PI e(CES �i i� 3 4q 9'9
-
Address:
Description:
Property Tax ID#: `oda`' �°�a �3�'d d4-<k Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right;Side: Left Side:
DETAILED Dl±�SCR'.PTIQN OF WOR
401D
VIA 0 UL12
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. CONST•�UCTIC7N INFORMAT �N:
Addilional work to be pertormed under this permit-check all that 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: $ 5� J Utilities: —Sewer _Septic Building Height:
USS
Name
: CONTRA C}
Name L3a(JCL AtjS'h!\ Name:
Address: �j�,Of 'W,LCC: 2C Company:
City: State:-IL, Address:
Zip Code: 3q q9 2- Fax: City: State:
Phone No. C-7220 '100 -0205 Zip Code: Fax:
E-Mail: C;aCki,6 if 4e-. (?)AA Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement-is required.
SUPPLEMENTAL CONSTRUCTION U'E LAW INt=ORMATI®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 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 thErfirst i spection. If you intend to obtain financing, consult with lender or an attorney before
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commenc ,g w rk or recording our Notice of Commencement.
Signature o 'Q}mner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF '� t'y��� COUNTY OF
The forgoing instrument was acknowledgi before me The forgoing instrument was acknowledged before me
this \_day-of i4NJ:N4 20_ by this day of 20_ by
as C. '9-it \ V1
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
(Signature of Notary P blic-State of Florida) (Signature of Notary Public-State of Florida)
Commission NoJC760_�-� (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
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