HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
L 9 LOIS I Q
BUilding Permit Application 2019
Planning and Development Services 9 Department
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
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Address: 91,1 SE '0r-,",r%n
Legal Description: ev'4 e-r ffizr(c
Property Tax ID#:3 LJ L 61--151 S-<)-a\e--j-nM-C4
Lot No. So
Site Plan Name: Block No.
Project Name: mp,c- jr,r, nx,o
Setbacks Front Back: Right Side: Left Side:
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AaClitional work to be performed unclerthIS permit-check all that apply:
E1HVAC Gas Tank Gas Piping E]Shutters 2Windows/Doors
Electric ❑Plumbing OSprinklers E]Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1440 Utilities:E]Sewer ElSeptic Building Height:
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Address: 2(J- SE Company"_f--4LC_�
City: P-64 Sr; V_ State:EL Address:1a!Jim 1t '79,"i- "r_ AJ
Zip Code:3 L-te 5 Fax: City: J 0, Ph I P6 ,ems 04, state:_FL'�—
Phone No.?_).2-S6 t 23 61zip Co d e:!3Sq 4 -a—— Fax: 5-Ed
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
I certify that no work or installation has commenced prior to the issuance of a permit.
-- -St. Lucie CountV makes rio 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.
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_Signatu of Ow /L ee/Agent S' nature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLORJl�A,
COUNTY OF S+ - � _U L I Pi COUNTY OF ('a l bq
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledgeeefore me
this day of 20 l�by this�day of U 20 by
(Name of person acknowledging) (Name of person acknowledging)
1
(Signature of a Public-State of Florida) (Signapdre of Notary Public- ate of Florida)
Personally Known ___�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced T pe of Identification Produced
/E `i cl "'t X 1 2 a�.�•. TAMMY M RTIN
Commission No. 1. 1 0 1 '1 J Pct `K—, Notary Public S�f��l r�d� NO. 2 PRYP�B AN65eQUNG
Commission d GG 182743 * 14q MY COMMISSION#FF 951069
My Comm.Expi res Apr 30,2022PXPIRFR-April 19 MO
Bonded through National Notary Assn. 9�FOF F`o�� Bonded Tnru Budget Notary Swces
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS