HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE I IF MAST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: 10. ` Permit Number:
RECEIVED
Bull ing Permlft AppkaVon SEP 10 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucieounty, Permitting
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 l
:PROPOSED IMPROV/EMENT LOCAT'lON
Address: a2)11 /l2YrJOY� Lata. a- - reYCa-i�L
Legal Description:
Property Tax ID#: SO — - Lot No.
Site Plan Name: Block No.
Project Name: yr,� A+kI I/)VCCZILZ
Setbacks Front Back: Right Side: Left Side:
DETAILED �ESCRfPT10iVyOF:11VORK�= - -
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p,QAC M1 la 110
CONSTRUCTION INFORMATION _ rx 3 g '
A itiona wor c to V e e orme under this permit-check la appy:
❑HVAC 13 Gas Tank -]Gas Piping Shutters Windows/Doors
0 Electric F] Plumbing Sprinklers F]Generator Roof Roof pitch
Total Sq. Ft of Construction: Scl. Ft.of First Floor:
Cost of Construction:$_�i�'-f- Utilities: _Sewer E]Septic Building Height:
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CONTRACTOR
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Name aAoVMMY,I Name: Yl',/i
Address: Vl.- Company: I r&y\.CC) COY, _u C_
City: �f!f k State:& Addressi:- l D 1 I LQ:E-J�JiSE F� E(1n • G� VJ
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Zip Code: '3ygt Fax: City: State:•LL -'
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Phone No. Zip Code: ��� -7 Fax:-7-22-09-622
E-Mail: Phone No.
Fill in fee simple e Holder on next page(if different E-Mail:\WV; ,�2-r��►�«)/Cv15�uc�►r)�11 r�l'..(�Lll��'
from the Owner listed above) State or County License: CG-0,151a-15� 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SLIPPLEIViEiVTAL;CONS 'RUCl`iOiV�LtEIV LAW�INFORiViATiORI� s � � � ? ,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE MOLDER: of 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 ya property.A Notice of Commencement must be recor��e'd and posted on the jobsite
before the first in ection. If you intend to obtain financing, consult wit l4inder an
attorney before
commencin,g wok or r Wing your Notice of Commencement.
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Sigriffure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF CL t�� COUNTY OF 'zi-Id yi-
The forgoing instrument was acknowledged before me The forgoing instr ment was acknowledged before me
this'N day of AZWZ,1 20 Eby this % day of rL 20 l by
(Name of person acknowledging) (Name of person acknowledging)
( ' ature o Notary Public-State of Florida} (S' ature of 'otary Public-State of Florida}
Personally Known_ OR Produced identification Personally Known_ OR Produced Identification
Type of identification Produced Type of identification Produced
o�tRYAUs JENNAL.FRANCO I co
Commission No. - • *a�ommission#GG32877 Commission No, o�1Yrao,(SeaIDENNAL.FRAN
* Expires April 29,2023 z �`t ' commission#GG 328778
se s * * s til 29,2023
oFf4 �� oFF�°�` sodadThruSudgdNotarySmIces; '
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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