HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO•BE ACCEPTED
Date: �/3
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Building Permit Application MAR 18 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie u nty, FL
Phone: 772).462-1553 Fax: 772)462-1578 Commercial Resident
PERMIT APPLICATION FOR:
IFIRNMIN9110111M,
+110RIEMENT L®CATJQN:
Address: �L/` /��f}l�s �edleh &e-i, aGI . 3075-7
Legal
075-
Legal Description: ,A SAII-5knez- ��1, C a270279��
Property Tax ID#: /V 3-02" 5-0) - 702- 7 -9i00 ' 3 Lot No. 5-Y
Site Plan Name: .44--e 7!lei Block No.
Project Name:
Setbacks Front Back: Right Side:, Left Side:
DETAILED DE=CSCR+IPTION OF WORK:
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z` �;�,�=++f4"• '�s�G� 7"101�� f^JIJr�
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RUCTIQN INFORMATION:
itionalMor to be pertormed under this permit-check
a, st.'at ap,p y:
`I '`;,1VIcfanical _Gas Tank _Gas Piping `' hutters _Windows/Doors
r leciic Plumbing —Sprinklers Roof Pitch
Total Sq. Ft of Construction: �a S. Ff...of`�i t Floor:
Cost of Construction: $ 19-01000 . Utilities: Sewer _Septic Building Height: F71
NER/
0 LE=SSE CONTRA OR:
Name /n' I fir. JJ Name: n /
Address: 71Y &;--i -Y Company:. cir- ,,11171'7 &1a ./ �1��• ii�G
City: SeI/r,z State:. Address: -1-71•
Zip Code: 0, AO Fax: 1 City: J�14syn 34" Stater
Phone No. 86? -���' p �J 33 Zip Code: 3�/q Jr7 Fax:772- V-.211V
E-Mail: Phone No 7 -IZO - 3713"
Fill in fee simple Title Holder on next page(if different E-Mail !e m i h c dio o •C9ir
from the Owner listed above) State or County License GQL l2 I�1a'f
If value of construction is 2500 or more,a RECORDED Notice of commencement is required.
SU�PPLEMENT/�l.C+®NSTIt�E1C�aTl®N !IE'N I..AW IFNF'®RMATt R'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 the permit 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 ecordin ur Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent f Signature of Contractor/License Holder M
STATE OF FLORI!22&
STATE OF FLORIDA
COUNTY OF COUNTY OF ��� x z.
The forgoing instrument was acknowledged befor The forgoing instrument was acknowledged before
this ► � day of IQ JRt ,20_�O by m .. this day of rn%Q 6_C 12- ,20_14 -by a v
r,r)
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Wary Public-State of Florida) (Signature ofary Public-State of Florida
Personally Known OR Produced Identification Personally Known_,c:-�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014