HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: VVS
RECEIVED
JUL 3 Q 2019
Building Permit Applicatio
Planning and Development Services 6T, huclo County, Permitting
Building and Code Regulation Division
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 �� C
PROPOSED 1MPROVEIVIENT:LOCATION ` k
_ a.
Address: Cil)f'O-P�
Legal Description: Lln ry- 'mile- 611) RW�, (a-1-
Property Tax ID#:34 r 03 0 Z10 000 Lot No._l�
Site Plan Name: / -<<�� :,5 � Block No.
Project Name: C�� �ci�E- S� r1 L,-_
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF 1NORK j = -
eT�V,
=CONSTRUCTION Q_ RMATION
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Additional work tobene orme un ert is permit-c ec a appy:
HVAC LJ Gas Tank Gas Piping Shutters indoors Doors
11 Electric 0 Plumbing []Sprinklers Flenerator 0 Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 2 Z C>!J UtilitiesInSewer Septic Building Height:
OWNER/LESSEE CONTRACTOR t.
Name 'hv 2 Cn..✓_ Name: or-t t Ti J n
Address: L✓L Company: e_f
City: -fete-L-e, State:�Pc_ Address:37 7, 1 E
Zip Code:JLl'19 Z Fax: City:� � Stater
Phone No.?�`l 3z1 110 Zip Code: C6? Fax:
E-Mail: Phone No.72 Z '?$( - S v-N
Fill in fee simple Title Holder on next page(if different E-Mail: GD 9- loci' [ ecS, L o Vl\,
from the Owner listed above) State or County License: 5t-c- 3$ 63
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAUV INFORMATION f ��� ;: x;�� ' � �-�
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: 1,c 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/Lice—n--se— older
STATE OF FLORI A STATE OF FLORIA�--4
COUNTY OF 401 ,-Lr:� COUNTY OF V�
The forgoing instrument was cknowledged before me The for oing instrny,�ment was cknowledged(�efore me
this day of 20�by this//day of JJ> ' ` 20 /V'by
(�rim � C ( � F S GiL.
Name of persc�making statement Name of person aking statement
Personally Known o'' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Idntification
Prod ced Produce
F
..r, s CpMMISS Gii274212
p :' � : #00 1Z _,,, �'" SIRES. S.2022
(Sign ture of Nota'—' (Signa re o
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17