HomeMy WebLinkAboutBuilding Permit Application 03/12/2019 09: 48 AM PDT TO: 17724621578 FROM:5617631006 Page: 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:S Permit Number: C L
RECEIVED
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wilding Deli Mit Application MAR 12 2019
Planning and Development Services 5T, �y i4 County, Permitting
Building and Code Regulation Division i
2300 Virginia Avenue,Fort Pierce FL 34982 ems'
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line >�
PROPOSED IMPROVEMENT LOCA-r ON:
Address: j1A r
Legal Description: t( S�C P1-y1-P—C C�
Property Tax ID#:'.,. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DI TAlL D DESCRIPTION OF WORK: t I n
YJQ
CO lSTkUCTION INPOR11IiATION:
Additional work toe e orme under t -checkispermit a appy:
HVAC 11 Gas Tank ❑Gas Piping Shutters Q Windows/Doors
nElectric 12 Plumbing Sprinklers Q Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft_of First]Floor:
Cost of Construction:$ 15 Utilities:nSewer F Septic Building Height:
OWNER/LESSEE: CONTRACTOR;
NameC ��g -' Name:
t' kJ
Address: 4 �� � ay Company:
City: uu t;s c State:FL. Address: In 7 W-) F J '0L
Zip Code: t��3 Fax: City: P-)& State: F/_
Phone No. 7 22: 6 5 `,3 SOS Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title bolder on next page(if different E-Mail: ezt t--Dpkl
from the Owner listed above) State or County License:-Cr<
Jfvaiue of construtiion is$2500 or more,a RECORDED Notice of Commencement is required. T � _ �--
03/12/2019 09:48 AM PDT TC : 17724621578 FROM:5617631006 Page: 1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE FOLDER: _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 re—izording vour Notice of Commencement.
;t
Signature of Owner/ ssee/Contractor as Agent for Owner Signature of Contract /License der
i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ COUNTY OF
The ing instrImentwas acknowledge before me The fo oin instrument was ack o ledge before me
this da f � r W/V by this a+� 0 by
1. �Pa
Name erson m301;g statefn' nt Nam person n�state ent
Personalty Known 0 Produced identification Personally Known f/ 0� roduced Identification
Type of Identific ron Type of Identification
Produced Produced
i
(61aar6ire of Notary A "c- ^id (Sig a of Notary Public- �)orida} n
_ omm}ssian GG101 rE GoMallon#GGI 01442
Seal lyes: 4,2071 a ?o-
Commission No. �. ( � Commission No. - ( ISS:ft 4,2021
Boned thm Aaron NotaryBonded Ihnl Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ----- -------- ------_ __._�
COMPLETED
Rev.8/2/17