HomeMy WebLinkAboutBuilding Permit Application 1 '
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ALL kPPLICABLE.INFO UST BE COMPLETED FOR APPLICATION-TO BE ACCEPTED.
Dat a: k \ Permit Number:
RECEIVED
Building Permit Application MAY o 6 2019
Pla ing and Developmentservices
Bu fing and Code Regulation Division ST. Lucie County, Permictirng .
23011 Virginia Avenue,Fprt Pierce FL 34982
Phone:(772)462-155113 ;Fax: (772)462-1578 Commercial 1//Residential
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PER IT APPLICAThON FOR: To Select from dropbox, click arrow at the end of line
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ROPO�S=D INn1/EME11 '; OCA_TIONY . y
Addr ss:
Legal Description: I ! h 7V1 D KW
PropE rty Tax 1 D#:a C'U o4� -,-1,4 - CWC, - Wo- Lot No.
Site P an Name: Block No.
Project Name: r
Setb cks Front Back: Right Side: Left Side:
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Add
i lona workto rj
orme un er t is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric !Plumbing .Sprinklers 11 Generator E]Roof Roof pitch
Total Sq. Ft-of Construction: S . Ft.of First Floor:
Cost f Construction:$ Utilities:Sewer Septic Building Height:
Nam Al S 1-, 1 Name: C,IL
Address: `z�i 5 4 Company: WC)
City: a (' Stater Address: 7$5' ((� G vtcl
Zip ode: 3`42 L ! Fax: City: State: _'4
Phon No. Zip Code:3Fax: 7
E-Mail: Phone No. 4.(61 Ll 9 S
Fill in fee simple Title Holder on next page(if different E-Mail: u)6 Bp I
from the Owner listed)above) State or County License: CAc ,� \-36 a
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If val a of construction! $2500 or more,a RECORDED Notice of Commencement is'required.
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SU PLEM NTAL`�ONS)T U TION LIEN LAW'PN�FORMATIO:N
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DE IGNER/ENGINEER:: Not Applicable MORTGAGE COMPANY: _Not Applicable
Na e• Name:
Ad ress: I Address:
Cit I State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Na e: I i Name -
Ad ress: I Address:
Cit City:
Zip: Phone: Zip: Phone:
OW ER/CONTRACTOR' AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I cert! that no work or installation has commenced prior to the issuance of a permit.
St.Lu �e 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
struct re.Please consult , ith 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 acc rdance with the ap raved plans,the Florida Building Codes and St.Lucie County Amendments.
The fo lowing building pe>jmit applications are exempt from undergoing a full concurrency review:room additions,
access ry structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WAR ING TO OWNER:+,Your failure to Record a Notice of Commencement may result in your paying twice for
impr,,vements to your property.A Notice of Commencement must be recorded and posted on the jobsite
beforle the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comt�tencin work or Ire'cordin our Notice of Commencement.
Sign ture of Owner/Les
see/Contractor as Agent for Owner Signature of Contractor/License Holder
STA E OF FLORIDA 1 " STATE OF FLORIDA f
CO NTY OF '^ ' r COUNTY OF
The rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,/tib 20� by this day of�_�i .20 `3 by
PersoName-of person!r1t`aking statement Name o person making statement
nally Known i !OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Type of Identification
Prod iced Produced
{Sign tore of Notary Pu til {S ate'of Florida) {Signature of Notary Public-State of Florida)
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� """' MIKE MARTIN """"" (Seal)MIKE MARTIN
Com ission No. ;'�P"'°bm�.,, (seal) Co mission No. �p�e,,,
Notary Public-State of Flo Ida :°. e`'o Notary Public-State of FEo d
Commission#FF 21695 * Commission#FF 21695
M Comm. j •* *�� 1
Bonded hrough National Mot Assn. 'f�' °�"°'`` y
��,""�"""�� Bonded hrou h National Notary)ss
REVIEWS FROM NS VEGETATION -MRTbE--:-M kNGROVE--
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DAT
RECEIVED
DAT
COMPLETED
Rev.8 /17
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