HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0`a.', \A, Permit Number: 1"l deo a 33
RECEIVED
Building Permit Application JUN 2 8 2019
Planning and Development Services II
Building and Code Regulation Division
ST, Lucie Cou Yr Permitting
Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
-PRO P.QSWIMP,RCIVEMEIVT LO'CATIO'N
Address: Ve-
Legal Description: 0 UA.0-e, P1070 151D 0 ( d P < 1
Property Tax I#: — Lot No.
_
Site Plan Name: Block No. . !
Project Name:
Setbacks Front Back: Right Side: Left Side:
[)ETAILED DESCRIPTION OF WORK:- .
New ba�AOIMQ
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a12hutters
ply*
HVAC Li Gas Tank ❑Gas Piping QWindows/Doorso
FlElectric 0 Plumbing Sprinklers I Generator F]Roof Roof pitch
Total Sq. Ft of Construction: (�~ —7 S Ft.of First Floor:
g9
Cost of Construction:$ �'—I "1 I / Utilities: Sewer F Septic Building Height:
OWNER/LESS-EL 4 CONTRACTOR:
Name v Y Name:
Address:22Z55 Neto Company: A.ES
City: 4 1e `�-. State.—T_— Address: 11J Ll Li
Zip Codec Fax: r� City: 6 1, t-- State:
Phone No. V�a�O Zip Code: 10 Fax: I of
E-Mail: Phone No. S4119 _nj k_1
Fill in fee simple Title Holder on next page(if different E-Mail: 5 c
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUOPLENhENTAL_CONSTRUCTIQN! LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: 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.
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 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 Horne Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit,I da 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 resu 'n your paying twice for
improvements toy r raperty. otice of Commencement must be re corde an paste the jobsite
before the first ins ect on. If you in end to obtain financing,consuth len r a an a me before
commencing work or rvcorcRng VoufNotice of Commencement.
y L/ I / V
Signature of O �erJ Lessee/Contractor a Age t for Owner Signature of Con r ctorjLicense der
STATE OF F ORIDA STATE OF FL RiDA
COUNTY O I rctl� COUNTY OF ct
The f of gin �rume t was acknowledg efore me The f oing' strum ent was acknowled efore me
thisa' 0 20by this Mda of ,20=1 by
Name of person making statement Name of person making statement
Personally Known � OR Produced Ident' c tion Personally Known X' OR Produced Identificati
Type of identification Type of Identification
Produced Produced
( ignature of N ary Pubic-Sta a of Fl Signature of Nota u 1� eef�,ylr rrr'
Y Pap Notary Public State� � ndaY Po@� Notary Public State of F rid
Commission a o c i $ Commissia lye M R;scaboni ea�)
? Kad 10 Riccabom
My Commission FF 981647 y- o My Commission FF 981647
- as Expires 05/28/2020 Ex ires 05/28/2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ftev.8j2/17