HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: Permit Number: o
KECEIV D
'.� AUG 2 6 2019
Building Permit Applic tion Department
Planning and Development Services
Permitting par
tment
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: q o, pp
Legal Description: y k e k) 4 ej
P r o p e rty Ta x I D#: U� �� ' DOLot No. �d
Site Plan Name: Block No. )021
Project Name:
Setbacks FrontN Back: Right Side: _Left Side:
J� 4 �!/i �I D/l s�rH !9* cS7`o.�.� /J�fh/l✓ f- / alylG
itiona work to b—ep—erformecl" under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
00
Cost of Construction:$Tt?9 Utilities: —Sewer —Septic, Building Height:
Name tfG l J Name:�
Address: '0 A I e 06 Comp6ny:CA�iJ1/�l',cS�l�v�l'fCiJg7�colyAr
city: 1" Pi'��C�P State: y Address: 2
Zip Code: Fax:' ... City: •.'� d".;.t✓Cc State
Phone No. 709-43 76 Zip Code: JLZ? �Idr Fax:272- /-6ziS
E-Mail: Phone No 77,2
Fill in fee simple Title Holder on next page( if different E-Mail r.0o4l, Sky 1 L ow vctieo. roe,4
from the Owner listed above) State or County Licensed'CG�3!/S'/.f08
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESlGNERJENGtNEER: Not ApplicableMORTGAGE COMPANY: 7( Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER:' _XNot Applicable BONDING COMPANY: y 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.
A
Signa re of Own Lessee/Contractor as Agent for Owner ►gnature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA. '
COUNTY OF COUNTY OF
The f rgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this, lay of -t 1 Lt3 .20 4by this day of 61__ ;20�j by
rq
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
�Lo4A
(Signature of NotaV1 Public-State of Florida} (Signature of Notary lic-State of Florida} 61
Commission No. '"" — Y° ' AUDREYB.HUt� y
io: :..;o'�"`°"� — UDREY B. "Uit7 HREY
Commission No ^*:` #: MYCU MtSStOtV#GG306g17
a. "';*; W COMMISSION#GG 340817 a` EXPIRES:March 6,2023
*, e; a F F; hru et2[y tt is U rwriters
Fodfl o. _ R�.
Bon s T Putrtic n
REVIEWS -- ,.�,. ISOR PLANS VE SEA r`l ROVE
COUNTER REVIEW REVIE REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED "
DATE -.
COMPLETED
lev.8/2/17