HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 a1 Permit Number:
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__ RECEIVED
Building Permit Application MAY 2
Planning and Development Services 2019
Building and Code Regulation Division -----
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Luwle��'klnvicA tc p�+n�ln
2300 Virginia Avenue,Fort Pierce FL 34952 9
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: Ko6 7.> Q 332'21 S+cce*
Legal Description: Sun t C nil Gn ccl ens
Property Tax ID#: qo5_-G6( -63 (3 "Coo -6 Lot No. I .a
Site Plan Name: Block No.
Project Name: G-e-6e-ne_ '(CO L1e.
Setbacks Front Back: Right Side: Left Side:
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Additional work to be ertormed under tFspermit-check all that appy:
❑HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric O Plumbing OSprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ (4 1 1 C1-L(5 Utilities Cn Sewer O Septic Building Height:
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Name otd,nt`t`'ce. O3UName:' - c i
Address: I(-,oa 3 0 33 rd S4rc.t t Company: .t-
City: 1''f, Pie.rGe. Stater Address: 1 '7 T
Zip Code:53L1q q 7 Fax: City: t`, - k - State:_F—,L--
Phone No. )?Q "?7G -O4S10 Zip Code3 a 9-- Fax: L-I
E-Mail: Phone No. 5 - V,
Fill in fee simple Title Holder on next page(if different E-Mail: ��''
from the Owner listed above) State or County ' ense: 1. c7- Y' 3
If value of construction is$2500 or more,a RECORDED Notice of Commencem tis required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: zip: Phone:
FEE SIMPLE TITLE HOLDER: Y Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 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
cowencing work or recording our Notice of Commencement.
s
—Signature of Owner/Lessee—'t Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-- Z u CO-a COUNTY OF
The forgoing instrument was cknowled ed efore me The forgoing instrument was acknowledged before me
this ,5'-day ofav J 20 by this day of 20 by
e4e ,.JvScuz
(Name of person acknowledging) (Name of person acknowledging)
2 6`
Signature of otary,Puub"lliic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known Y OR Produced identification Personally Known OR Produced Identification
Type of Identification Type of identification Produced
Commission No. =y = MV COMDN it Ff� Commission No. (Seal)
EXPIRES NovemW 11.2019
• .carr.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS