HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
r
JUL f01 2019
Building Permit Applicatio T.
Lucie County, Permitting
Planning and Development Services -- --
Building and.Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V
Phone: (772)462-1553 - Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED NPR01/EMENT 1.00ATIO
Address: 4-Ai . Los
Legal Description:
Property Tax ID#: 130 0 j?O?/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: . Right Side: Left Side:
DETAIIL�D DE�SCR�FPTIO • F WORK:
CO STRUCTION INFO
Additional work to be performed under this permit—check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ /qoD Utilities: _Sewer Septic Building Height:
OWNER/LE�-SSE. CONTR CTR:
U
Name :. r; �1 t'YY� Phi`. Name: ? r ;
Address: "7 l `n'.ve�iy'f - "� ' M'T�✓& Company: u ;> U
?n J14
City: I (QG - �.w dF,•,,:,d.. : .. State: Address: ,0
—T�
Zip Code: Fax: d City: 7 Stater/
Phone No. �7y�_i�l � Zip Code: ?7wh7/ Fax: --6 72,-- b
E-Mail: Phone No f
Fill in fee simple Title Holder on next page(if different E- itLAE—es Izie
i �
from the Owner listed above) State County License 16�10' 1 OF®0 9(.T-"J65z
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
NUI PPEMENTI. �QNSTR .GTI�N N W d.RMAT1:0
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 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI STATE OF FLORID t
COUNTY( F M� L�0 �� COUNTY OF ��
The for oing inst ent was acknowledge before me The forgoing instrument was acknowledged before me
thisday of 1.�K1� 20� by this day of_' / y — 20_Bby
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
_ l
(Signature - at(e -
Notery Pub is �� *� (Signature o
Bonnie L Staflin9 �`r Notary Pubim State of Ftodda
Commissio o. omm wnnG�22R@a1) Commission Bonnie L Starting /S al
+ aA Expires 12022y` y ion GG 22979
�ijaw� Exp�res08 12022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE' .
COMPLETED
ATE-
COMPLETED
Rev. 8/2/17