HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit u e R&_ 4s?
�- ED
•
Building Permit Applica ion . SEP 2 3 2019
Planning and Development ServicesPermitting Department
Building and Code Regulation Division fitLucie Count FL
.
2300 Virginia Avenue,Fort Pierce FL 34982 �i
Phone: (772)462-1553 . Fax: (772)462-1578 Commercial Resi entla
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: �/� D // / /
Legal Description: V_An,J4 G 'nlec Cooh�ry Z' [v�J' 1/ tLGa yt Lc°41e�ale ES TA le_)
n✓ a.1 e-2 c79 ) TA11/44.E o-'-1-0 e, 4,J -down rn c - :73 87- 639 4e4* ; 1o)
Property Tax ID#: /.go/- DO D- 0 Q'9 - 00 O Lot No. _
Site Plan Name: A,'1W Block No.
Project Name: Ale oa`�rsOn
Setbacks Front Back: Right Side: Left Side:
Additional work toe e orme under tispermit-checka appy:
HVAC Ei Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric El Plumbing Sprinklers I Generator 0 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
,J o a
Cost of Construction:$ 3. ��7 Utilities: _Sewer E]Septic Building Height: _
Name AZ,4.e,-1 C ke ngler ✓1 Name: Z -J v C
Address: D1 Company: 0 ti J
City: f J��G:r Stater Address: ,1 6 c/ , -� 5 l"W
Zip Code: 3 Fax-. City: e/Cc State:-/'
Phone No. -5-10 7-290 3 93 Zip Code:.36 Z6 ,
Fax: ?V-4 -6�J
E-Mail: IV A Phone No. 722-
Fill in.fee simple Title Holder on next page(if different E-Mail: '17JW, c1 �v )C ® f/a oa, Ca✓j m
from the Owner listed above) State or County License:_sc
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: f Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone:, Zip: 'Phone:
FEE SIMPLE TITLEHOLDER: Y Not Applicable BONDING COMPANY: '/hot 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.
i
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 recordinR your Notice of Commencement.
0231-12 .�
_Signature of ner/Lessee/Agent I ature of Contrac License Holder
STATE OF FLORIDA- STATE OF FLORID _
COUNTY OF COUNTY OF
The forgoing mstru ent w s acknowledged before me The ,!ping instru ent was acknowledgVefore me
this day of 5�-t` 20� —..by this day of e i"" 20 !/ by
DJr�rn h. 6 i'C— 10-n P?V Ski p .
(Name of p rson acknowledging) (Name of pefson acknowledging)
(Signature of Nota ,uubllic-State of Florid (Signature of Not Public-State of Florida)
Personally Known OR Produced Identification Personally Known' OR Produced identification
Type of Identification Produced Type of Identification Produced
II
Commission No. 1ii2111 1,11 JE Commission No. S
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DATE
COMPLETE
INITIALS