HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: t Permit Number:
RECEIVED
Building Permit Applic tiOAAR Q 8 2019
Planning and Development Services ST. E"NFf�rANti@a (" � � �
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:
Address: 3 D y Likes'
Legal Description: Jtill
Property Tax ID#: /3o?7^ 70/ Lot No. 17
Site Plan Name: Block No. 146
Project Name:
Setbacks Front Back: Right Side: Left Side:
,.'N L �p
i WE
Additional wor to be pertormed under tis permit–check all that appy:
_Mechanical _Gas Tank —Gas Piping (Shutters _Windows/Doors
_Electric _Plumbing —Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
00
Cost of Construction:$ . 0! utilities: —Sewer _Septic Building Height:
Namef'QrM el O AG/Yq h ie Name: or" /&
y Address: 34 d 214',o Cg4j TG✓ Company: C Ogd/4
City: C, State: r1 Address: 62" J4, cTjl 1-4Cse d31.al
Zip-Code: 3 Fax: City: re State:f=K
Phone No. 97x3^ 9`O`66�3% Zip Code: 7 Fax:77.2-
E-Mail: Phone No. AlKI-o?V/V
Fill in fee simple Title Holder on next page(if different E-Mail: '/ D rn ✓44,00, c.0.*,"
from the Owner listed above) State or County License:dc-C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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: _VNot 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,lbylaws 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'requ'ested permitj do-her`eby agree that I will,in all respects;peifor'm'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 ur Notice of Commencement.
Si 'ature of Owner/Age. Lessee - S n , re of Contracto License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 5 �. 1•uc��
The fo going instrument was acknowled ed before me The for oing instrument was acknowled ed before me
this day.ofg 20� by this day of Md►C 20-1 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publ State of Florida) (Signature of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ProducedType of Identification Produced
.........•. DEANNA MARIE GIV '
Commission No.640-c-adl.3 Commission No. a. ort
SIE GIVENS COMMISSI��Qi�l�
pFANT� 022023 A" *,1 EXRIRES:December 16,2020. '
;ou?'• OMIJ11SSlON#GG 2020 !''.�i. '.e
F o,.• Bonded Thor Notary Public Underwriter`
Public
REVIEWS FR ON' =;T„.` =N '"'x PLANS VEGETATION SEA TURTLE _ MANGROVE
FOFF
COUN R'' ”' REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014