HomeMy WebLinkAboutBuilding Permit Application f I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:.����.�.� Permit Number:
R CE!VE
--- -=- — AUG 2 9 ''019
Building Permit Appiicat on
Planning and Development Services ST, Lucie County, Permitting
Suilding and Code Regulation Division -
2,300 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: �i��, '? S Q- _t")r-w "na't l so('_0
Legal Description: C rT rc,:s C.D,r%c-Jz%tr`,i,nt u rr1 f/n�+ ��C 1
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Property Tax ID#:q50 D -6 aQ•"011`-d`-ong - Lot No.
Site Plan Name:,, Block No. '
Project Name: Dau Ck.
Setbacks Front Back: Right Side: Left Side: {
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Additionalworkto e performed =under
� iFsa permit—
cecq:'acx.-., a:�pp"iy
HVAC OGas PipingShutters
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7Windows/Doors
L^1 Electric Pfumbing ❑Sprinklers F]Generator Roof
Total Sq.Ft of Construction: SQ. Ft`.of First Floor:
Cost of Construction:$ tO"�C_�5,53 Utilities:L lSewer QSeptic Building Height:
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NameName:
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i Narne: �y�tir�`7T-x-,43 '",.`, — ��•� S-i;c'e
Address:fi. 1:,n c�3. jlUa{ Company:,-_14-'
City:R _� qh s isz�ft�. State: Address: l?,a tg '"1 ,Tf I (
Zi Code:�C1 LO P City: i �% �-
p Fax: `4 '1v� --iC, � Stater
Phone No. - �' zip Code: y l :- Fax: Ll 995`
E-Mail: e- Er Phone No. (II iI_'.`�_` ., 41C-1
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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DE5iGNER/ENGINEER: ____Not Applicable . MpRTGAGE COMPANY: Not Applicable
Name: Name: i
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 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
comnVncing wql;;Ir.�corcling your Notice of Commencement.
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.—,Signature of Owner/Lessee/Agent ture of ontractor/License Holder
STATE OF FLORI STATE OF FLO IDA
COUNTY OF �h D�� COUNTY 0001,I/IN
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this.04'day of '7d'J1_ 20 LV-by this day of 1— ZO by
/tName of person acknowledging) (Name of person acknowledging)
ignature of Notary Public-S of Florida) (Sig-n—atuXof Notari
Public-Staee of Florida)
Personally Known OR Produced"I'ddhtifilt2tibri i'�rspnal.ly Known OR Produced Identification
Type of Identification Produced Type of Identification roduced
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Commission No. A--r6— l IDD3/ �Pp PAULA �c�rQQ�'lssion N qR4 (Seal)
WCOMMISSI #GG 190031 =o� ,... �� ANGELAYOUNG
EXPIRES une 25 2022 + ., , * MY COMMISSION#FF 951069
efs Nl oe EXPIRES:April 12.20-20 j
Revised 07/15/2014 9'Fo"c•_oF 5onded rnru Budget Notary Srrrices 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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