HomeMy WebLinkAboutBuilding Permit Application 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
{ Date: 7 Permit Numb r a,Tit C
JUL 23 2019
Building Permit Application permitting Department
Planning and Development Services St. Lucie Count FL
Building and Code Regulation Division _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: - 1 ()11 - "S I a RCpic S'
Legal Description: a C Y 3 '7 • & o
(ft W 44ICJ / t cyS i
Prope 4 Tax ID#: GCS/1 Q �CSC/ Lot No.
Site Plan Name: 511 qn c V 0,q -� Block No.
,=Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAtI.ED DESCRIPTION OF WORK777
-
VL S
CONSTRUCTION [ON'-
Additional work
or. to � orm e
�HVAC under t is permit—check a apply:
GasTank ❑Gas Piping _Shutters E]Windows/Doors
DElectric F Plumbing Sprinklers O Generator Roof
Total Sq.Ft of Construction: Cp-Q S of First Floor:
Cost of Construction:$_�d��(� Utilities-inSewer Septic Building Height: C-F-f
OWNER/LESSEE CONTRACTOR
Name e ,LvL C OV vt 0 e U r Name. c¢ C
Address- L/ 0 t oav Company:
City: l �C. State: Address: E ft fd
fi State: /
Zip Code: 3�r Sl Fax: 'l/ City: lt'i �`
;Phone No. O 0 ~ L C Zip Code:3 YY� - Fax 7 22 VK6 F*Ff7
E Mail: Phone No.
Fill in fee simple Tide Holder on next page(if different E-Mail:
(from the Owner listed above) State or Coun 'cense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGN ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address•
may; Stater CRT. .
Tip; Phone: Zip:y Phone:
FEE SIMPLE TITLE HOLDER:- - _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name: --
Address: x Address: -
� Phone: Zip." Phone:
I � _
1 ci rt*that no i mil or installation has commenced prior to the issuance of a permit
St iude County makes no rep onthat isgrantiog- tmity f a the��holderto build the subject structure
which im oontiid wnh a�apnple Home Owners on Hiles,��or and mve� s that may restrict or pmtnbit such
structure.Please consult with your Home Owners Ammon and reWew your deed for any restrictions which may apply.
in consideration of the granting of this requested permit,I do hery agree that 1 will,in all respects,perform the work
in arj cordanoe with the approved plarm the Florida Bu9c ft Codes and St Lude County Amendment.
The foilowing'biAling permit applications are exempt from undergoing a full concurrency review:room additions,
acctwory structures;swimming pools,fences,walls,sign.,screewroonand accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commit may result in 11ouvwying twice 1br
impprove n is to your pn3perty.A Notice of Commencement must be recorded and posted on the jobsite
before th first inspection.If you intend to obtain finandng consu with lender or an attorney before
oomm n work or recordin our Notice of i0ommen'cement
Wmllifm of Owner/Agent/Lessee Signature of ContratLtoi Holdw-
STATE OF FLORIDA STAR OF MMDA
COUNTYOF COUNTYOF
e
The was acknow me
The was admowhdVd before me
��►of - -20 ,by p -day of m— by .
(Name ofperson adarowledglrrg) (Nameof person aclarowled")
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(Signature of Public-Sta1De of Florida) ftature of Notary -State of Florida)
P o M--Kw m / OR Produced tdeMfica6on PwsoraNy .rwwnµ OR Produced klentillcatlon
Type of kU301cation Produced Type of Ideni fecadon Produced
Come msdon No. Seal conmbdon -BEY B.HUI .
B.HUMPHREY' `� `•�Y pP"= MY COMMISSION#GG 300817
ReVlsedU7/15/ FOFF' a EXPIRES:March6,2023Si� BondedThroNotaryPublicUndervvrilers
orrcled lTttu Notary Poblic Underv'ter,
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