HomeMy WebLinkAboutBuilding Permit Application 01 Y '
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: C I,U� ( � �n
® - RECEIVED
Building Permit Application JUL2019
Planning and Development Services Permitting Department
Building and Code Regulation Division - St. L u.ch COU-Ity
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential V'--
PE RMIT
JPERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
RROPQSED IIVIPROVEM,ENT LQCATION z
Address:
o(H (4' e SGy 5 �
Legal Description: L-aK -C�acl
Property Tax ID#A�)o -(_05 -oal S -Oo'q Lot No.��,7
Site Plan Name: Block No. C 3
Project Name:
Setbacks Front Back: Right Side: Left Side:
D;ETAL IQDESCRIPTION OF,WORK
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CONSTf3UCTI0N I'NFOR'MATION -
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Additional work to be DerFormeci under this permit-cheCK all appy:
11HVAC Gas Tank ❑Gas Piping Shutters .D
— �Vdindows/mss
Electric 0 Plumbing Sprinklers Generator 0 Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ l q 55. (__0(4 Utilities: _Sewer ElSeptic Building Height:
QWNER%LESSEE r � -
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Name CJS L O C a n l'O� c l" Name. i5Gti'xii��✓`..
Address: X70 F(� �,� s �( Company:.
City: Ft, i9,.(!:(-C, e. State: F l Address: .H(a
Zip Code: P4,d?s( Fax: �, e_ 1.
City: z` /��qC' lft�--� State:_E�'-
Ph
one No. -?-)a `4? t `�3 /� ..
C7 Zip Code:����. �-- Fax: �C�(-.�.�� ; '�S'�
E-Mail: Phone No. ci5--a
Fill in fee simple Title'Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMEN 1"AL'CONSTRUCTIQN<L}EN LAIN 1111FCtRMATIQN i
DESIGNER/ENGINEER: `Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: TNot Applicable
Name: Name:
Address: Address: 1
City: City:
Zip: Phone: Zip: Phone:
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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.
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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.
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_Signature of Owner/Lessee/Agent nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO Dl -
COUNTY OF `a1 LJJCi It COUNTY OF A t j p C't�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of _ tj fte 20 &by this�day of-y�S ,zo 44-Pq byi
i ft//Y) r,- 12. n IAS
(Na ,e of person acknowledging) (Name of person acknowledging)
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(Signature of otary Public-State of Florida) (Signa re of NoZary Pu 'c-State of Florida)
Personally Known V _OR Produced Identification Personally Known +�- OR Produced identification
Type of Identification Produced Type of Identification Produced
f Commission No.� 12 y'w,�, �,BARCOMB Commission Na. �p�PRr'Pu��r A G� Ns
;�{ Nnrco�nss ON#FM3427s * t r col�r�i slor� ri sslass
ffi 2tl19 N Qe EXPIRES:ApHI12,2a20
FoF Fidvanded I N Mud01 NQWY,'Ulyl
Revisedd 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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