HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: Permit Number:
RECEIVED
- _ BUilding Permit Applicati n APR 2 3 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: J
Address: -toa Ce
Legal Description:
Property Tax ID#: lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
13.E ` `T U1ti WQ 'K:'
Additional work to be pertorne un er t is permit-c ec a t at app y:.
-1(Iechanical _Gas Tank —Gas Piping _Shutters i Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: / Sq. Ft.of First Floor:
Cost of Construction:$ L (0007 m Utilities: —Sewer _Septic Building Height:
Name �►'' _ f �C �- Name: r
Address• I Xct. r r Company: _ �Gl
City:_ �• � tate: Address: tRi
Zip Code:: Fax: City: _ S11 Stater
Phone No. '77 - -� 2-2 2- Zip Co e: O p- Fax:
E-Mail: Phone No Z- O CD
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/EN GINEER: _Not Applicable MORTGAGE C ANY: _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.
1 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-holdef 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,l do hereby agree that 1 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
comq a cin work or recording our Notice of Commenceme
/31
a_ &Q'k A A. A�
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF / COUNTY OF
The fpWing instru nt w acknowledge before me The fo ing instru a nt wacknowledge before me
this day of 20J by this. day of 2017 by
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification >/
Type of Identific 'efl Type of Identification—
Produced Produced
(Signatu a of Notary Public-State of Florida) (Signatu a of
``c, y p�a('��i KA tN SEN
Commission No. ,``VP's% KAREN §e IELSEN o:State iof
n Florida Notary Public
(. Commission +_ -sion #G84
a=q ta o of Florida otary Public o":
=• Commission # GG 207484 ,9� �� My Corrmission Expires
"` June 12, 2022
June 12_,20'
, 022
REVIEWS R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
-DATE
RECEIVED
DATE .
COMPLETED
ev.