HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —
Date: �` Permit Number:
IVED{
Building Permit ApplicationL- E
8 2019
Planning and Development Services
Building and Code Regulation Division nty, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSER IPftC31(EMEIT JLC)CA � l ��.. .. .4. 3 ;.,. `�., __-,
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Address:/0 6 Iq L&6 ()1a5 J�Cii kr e, l eco been Mead FL
Legal Description: Bep_,, n C lx.�� �LO�lP J�`� O(/1 Ot✓�e,~ t
Property Tax ID#: 6>0,_4 o0O— 3 Lot No. 0
Site Plan Name: r ie h eik—, —f3e4"U e_-r-- Block No.
Project Name: IM io-h e-a-e—
Setbacks Front Back: a Right Side: (o Left Side: �r
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p� CR�TIC}(tF WORK
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Additional wor toe e orme under this permit—c ec a appy:
HVAC E]Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric El Plumbing Sprinklers Generator 11 Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ X3.(0®® Utilities:n Sewer 11 Septic Building Height:
Fes' ;�`t a � a '^ f v x b �§.a y � _ .�� �� t� �
`40'W"",IER�/LEE }NTROTOR �� ,
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Name eh e_1(-e, e-(— Name: �zkjc ch,rnl�I 1 A,
Address: (0(05 5LJ wag l Sy% I L)()L u/ Company:5+-L.&.V- ' nCL' CodVl
City:&k,LG ,+ State: Address: PC) 1500 j_U(A
Zip Code: �455'17 Fax: City: �'344J-O_41+ Stater
Phone No. 7 7a '70 I '3 a Zip Code: 1)-9'9.i Fax:1'l o1�ag95
E-Mail: Phone No. 7
Fill in fee simple Title Holder on next page(if different E-Mail:5"-+,P_;1Ce, t�1'le(�5 OLl`�l d1 e
from the Owner listed above) State or County License: x09 '
7r?
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SmUPPLEMENTAL CaNSTRUCTfQN LIEN-LAW tNC}RMATIC?I :.
DESIGNER/ENGINEER: NotApplicable MORTGAGE COMPANY: _✓Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: t-Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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.
s
_Signature of Owner/Lessee/Ag nt Signature of Contractor/Lic se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF !Ma-C-I-6 V1
The forgoing instrument was acknowledgedAefore me The forng instrument was acknowledged before me
this —day of i'1/�N-rd—, 20 `�by this day of MC�(/C1�1 20 1'? by
0_'�, P.54Q_r 13,ej1 wu-yt-ck— C�4 L�S`�-V �l ej-) ry,
(Name of person acknowledging) (Name of person acknowledging)
(Sig ature of Notary Public-State of Florida) (Sig ature of Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known_L OR Produced Identification
Type of Identification Produced Type of Identification Produced
CommissionF54,
s y CommissifrT
Notary PublleSt�leof I"&►YrublicState ofFlorida 8�
Diane K Bond My Commituion 00 485707
a Exaires�a✓aarao4z �
Revised
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS