HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r Permit Number:
= 1111116 RECEIVED
Building Permit Application JUL I X 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St.Lucie County
2300 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
PROPOSED IMPROVEMENT LOCATION:
Address: 11,31 W 2
Legal Description: NeAkO-6� Mandl loc I fs, CQn6Ac) Se_C.-VionU :2culte I In I
6
Property Tax ID#:=p -IS - a Lot No.
Site Plan Name: lr - Block No.
Project Name: Re - a
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�_eynnove (NkSl kkgq V0 0 d�ow� �C) �QOF �4e�IL. 1 v�S �� "fLAJ (�iV1Ut
ol-10 C+Wicoc�n�ess), I ' SkAokdiviy SecAm MXeA-co Twc_
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: JITI . Ci 01
S . Ft. of First Floor:
Cost of Construction:$ S, Q d_` , Utilities:cn5ewer Septic Building Height:
T
OWNER/LESSEE: CONTRACTOR:
Name ` ^' Name: 1
Address:_1131 �-P 1 Company:
City: G\ State:FL Address: Woe
J
Zip Code: n Fax: S "City-_?6(- ° e State: FL
Phone No.�1^I� c� q-31�oO Zip Code:3'�-1'q� Fax: N, I
E-Mail: CC) Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: g j ,
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I )
SUPPLEMENTAL CONSTRUCTION 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 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 k or recording our Notice of Commencement.
Signature o caner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE O FLORIDA `` nn STATE OF FLM�w
/-
COUNTYOF � ��, ;�"CCOUNTY OFC,I C
The forgoing instrument wa acknowledged before me The for oing instrument was acknowledged before me
this 4 day of _)� 20. by this l T day of J LA 20A3 by
��n h '611225
Name of perso making statement Name of pers making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary P lic-State of Florida) (Signature of Notary Pub' -State of Florida)
Commission No. EL(Ia&q.VAUGHN Commission No.
20 ��-State of Florida-Notary Public c '�Pt�Notary Pub gt� of klorida
*= Commission #GG 270079 ? Deena M Sabella
=9 Q My Commission Expires y� Qo My Commission GG 229100
m,,, c olz�niras 06/14/2022
,. ..._...., 2-042
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IN
REVIEWS FR G SUPERVISOR PLANS VEGETA SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17