HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: !. Permit Number:
RECEIVED
` MAR 4 7 2019
_ Building Permit Application
6T. Lyt(@ Cpuncy, Perrnitting
Planning and-Development Services _.
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:
PRaPOSED INPRflVEM'ENT LaCATI!D'N:
Address. �� z� :l—r-/'�9u
Legal Description: .SOS" � � 141
Property Tax ID#: ��/ 5-30 O/93 000 Lot No. Nfp'_7
Site Plan Name: Block No. J"7
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D9000-R PTION 4F W 11RK•
,4// z;46z GG /o X/5/ S A
=-STCTtON INFORMATION:
Additional work to Be performe.cl un er t is permit-Check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 1�.S��� Sq. Ft. of First Floor:
Cost of Construction: $ ��L�„.®� Utilities: _Sewer _Septic Building Height:
OWNER HIPS E CONTRA O � :
Name Name:
Address: 34'$ S� `T2 _�1/ ,�a ✓c Company: vo
City: 405 L State: L Address: 33 4F,^re^A/ r1--r-
Zip Code: 9_3 Fax: City: iiG�1G��- State: /rte
Phone No. Zip Code: Fax:
E-Mail: Phone No r7�7 a _a l 1�f �I-1� 7 F
Fill in fee simple Title Holder on next page(if different E-Mail �r L( o
from the Owner listed above) State or ounty License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S ' 'L�MENT :L.Ca'N�T'�, C71ON LI � .LAW INS• R11/IAT1 � .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Sign w r e Contractor as Agent for Owner at of n a r ' rise Holder
STAT O ORI STAT FLO
COU OF S - �-`���� COU OF mak, X-N c
The forgoing instrument.was acknowledged before me The fo4oing instrument was acknowledged before me
`
this'\ day of N 20\1 by this "1 day of 20A by
Name of person making statement. Name of p &son making statem nt.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced . L Produced1, L
(Signature of Nota Public-State of Florida) (Signature of Notaryublic-State of Florida)
Commission (Seal) Commission (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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