HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 04[L-
Date: Q 2 Permit Number:.
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ECEIVE
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_. ._-- .•_ - _ _- --- LResien
P 2 3 2019
Building Permit Applicatio
Planning and Development Services ng department
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: G �Yldn�c/��/ Wa por/ ✓ L�<"► �� ,3y9.Ta
Legal Description:aA Larose Guv4W ?,K, NO jla� 41/a✓/'AZ LyC C`,Y 0,���
Owh 720 de,.q
Property Tax ID#:_-4/,2S ;f 00 -11.2V-DSO ^ y Lot No. 6
Site Plan Name: Block No.1 30- 2-
Project Name: V'a.& r��
Setbacks Front Back: Right Side: Left Side:
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itiona wor to e" e orme un er t is permit-cneCK a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers 1:1 Generator Roof Roof pitch
Total Sq.Ft of Construction: oa S Ft.of First Floor:
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Cost of Construction:$ 3'9� Utilities:0Sewer 0Septic Building Height: _
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Nameea P41 1/AJ;le Name: rHul !e
Address: 6 owe''w -erems/. Company: CQaro/'X f/v ei! hdy7y
City: dole'/ &C.h State:�W Address: 6/ 36 I
Zip Code: :7 V 1)s•2 Fax: w14 City: p��• /�•ci<< State:
Phone No.__77 7-R 63S- Zip Code: 3 1110fd Fax:
E-Mail: /1/•//, Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: A"? le c.;; 1/,►4Qa• Gores
from the Owner listed above) State or County License: Je_e1J.1/J-1 X-OR
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER. Not A licable '
pp MORTGAGE CQMPANY: �l Not Applicable w
Name: Name:
Address: Address:
City: State: City State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: __)4NNot 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.
Inconsideration 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 addit-ions;
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 oh'the, jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our otice of Commencement.
nature of Owne esseejContractor as Agent for Owner Srgnature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORI
COUNTY OF_ cam ' t- 1iL C16t� COUNTY QF � C%11�•
The fo_%oing instru ent wa acknowledged before me The f r oing instru ent wa acknowledge before me
this.�S day of t 4 • ,20!� by this day of ._1-/1 20 . by
M rn Vi n L/ c' .
Name f person making statement Name f pers�op.rnaking statement
Personally Known i./ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
{Signature of No ry Public-State of Flori` a) (Signature of Nota Public-State of Florida
Commission q:«n'rid AUDREY B.HUM Comm AUDREY B.HUMPHREY /
ic(t•., � e
'- filOtiSai@M#GG 300$i�
� MY COMMISSION#GG 300$17
EXPIRES:March 6,2023 ;�a.�. :a: EXPIRES:Mariah 6,2023
o. ?,F aQ• Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW' REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17