HomeMy WebLinkAboutBuilding Permit Application 1
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ALL A PLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Dat I: EA1� i Permit Number: 1 O(���0( f,3
i "6° -- - -I I RECEIVED
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I {Is`D0� Fb..t�� U_ eS!___- i APR f 2019
1 Building Permit Application
Planning and Development Services Permitting Department.
I St. Lucie County
Buil (ng and Code Regulation Division
2300 Virginia Avenue,FgrtPierceFL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial IResidential
PERMIT APPLICATIION FOR: To Select from dropbox, click arrow at the end of line
PROAddres?OSEDDII.11�%PRO'VEMENT LOCATION: _
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Legal )ascription:
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Property Tax ID#: J U f j ca L('7 ' 0305 - COO ' 3 Lot No.
Site Plan Name: ' Block No.
Project Name: '
Setb cks Front 1 i Back: Right Side: Left Side:
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r DrrAlLiD DESCRIPTI1ON'.OFWORK,
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Ay (‘ V.-,na,\'� 3S..,-VI c 1 cc9y)citor?sc.,--- cm- S ca
CONS TRUCTIOk INFbRMATION:
Additional work to be erformed under this permit-check all apply:
HVAC Gas Tank Das Piping _Shutters Q Windows/Doors
0 Electric Plumbing El Sprinklers I1J Generator 0 Roof Roof pitch
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Total i q. Ft of Construction: S9:2.4 of First Floor:
Cost of Construction:$ ://Cc) Utilities: I I Sewer 0 Septic Building Height:
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OWI14ER/LESSEE 1 . " CO'NTRACTOR: .
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Nam �T��c`a. e � �/ cJ� �f1 �' ��' Name: fLd cam`-j� � ./r7 n/
Address:56? Li 5 i-/W y/' . . Company: L 1-t- it, r I civcci :+ rvY i.��
City: I �� - e t e!eJt �P State:/-5-.2 Address: '375T Ofec-vz ci e,-- �,-e. .
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Zip Ciode:3 LI?$, I Fax: City: f-4- , P :etre State: .,.
Phoni No. � i Zip Code: 31' 9 Yo Fax: LI 6 c/"l 1 a y
E-Mail: i _ Phone No. -L Ll GO oZ 9
Fill infee simple Title Holder on next page(if different E-Mail:(-JO) i cop d .`1--; Se ' aril.4 .
from the Owner listed j above) State or County License : l' �C I a k 3(� a- I
If vale of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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.S.UFIPLEMENTAL CONSTRUCTION LIEN`LAW INFORMATION `
• DES GNER/ENGINEER:; _Not Applicable MORTGAGE COMPANY: _Not Applicable
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Na e: Name:
Add ess: I : Address:
City: I ! State: City: State:
Zip: Phone
p � � � Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Add ess: I i Address:
City: i City:
Zip:
I Phone: Zip: Phone:
OWNR/CONTRACTORAFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifythat no work or installation has commenced prior to the issuance of a permit.
St.LucielCounty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which its in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structulre. 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.
mitThe fol owing building perapplications 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
beforg the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signa e of Contractor/License Holder
STATE OF FLORIDA J ; STATE OF FLORIDA //
COUNTY OF - �c • -C._ COUNTY OF -G-t- •r
The forgoing instrumtwosaicknowledged before me The forgoing instru nt was acknowledged before me
this )(P day of P G'. i ,20 19.by this / e day of Jr'. ! ,2012 by
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5 c----) l� /) rm LS c lav ` /J c
NanTiof person wking statement Name'Sf pernsonnmaking statement
Personally Known OR Produced Identification Personally Known /' OR Produced Identification
Type of Identification I ; Type of Identification
Prod iced ' i Produced
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(Sign ture of Notaryi F Q �nQIKt MAK IIN f MIKE MARTIN
ilidist4 ' 40„A.0.1.; .. _ , ____ _ _
• $of l rid (Signature of Notary Pub Florida
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r, 4 11 o ary Public-State of Florida M _� —�,��; Notary Public-State of Florid a
i_s ; �± :• Cor on#FF 216951 •„ •_ sloe�Y FF 216951
Corn ission No. � I Commission No. rrl P; C �¢
My Comm.Expires Apr 5,2019 "„r�� a• My` omni.Expires Apr 5,2019
''•,°A Bonded through National Notary Assn. M •4FOF F�gP�•• Bonded through National Notary Ass n.
REVIEWS FRONT i ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ' { - .
RECEIVED
DAT
COMPLETED j
Rev.8 2/17
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