HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE/INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED F'/
Date: 0—� `T- /Y Permit Number:- V 1
i ! 5
RECEIVED
Planning and Development Services building Permit Application
OCT 1 1 2 0 1 9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie C OeL Permitting
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE: MRCL, 114 V
PROPOSED IMPRQVEIVIENT L CAT N. -
Address: M C& j 1 S�4.
Property Tax ID#?j' gra 3462 0014 VOq Lot No. C/
Site Plan Name: Block No.
Project Names—EPA-e e6n.A-Y1
DETAILED:D.ESCRIPT(ON OF WORK:,,,
Wmm
■ �-\sM`V Y\ A \
CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all that apply:
✓Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction::,rr Sq.Ft.of First Floor:
Cost of Construction:$ `7'rG Utilities: _Sewer _Septic Building Height:
01l1INER/LESSEE:' CONTRACTOR:
NamName:
Address: 4 l A Company:
City: .. of*--a State:_ Address:
Zip Code: !3LI48 C Fax: City:AWA&�. State:
Phone No,-305-4031;1-00T Zip Code:55'3`+81— Fax:
E-Mail: Phone No D 3 S
Fill in fee simple Title Holder on next page(if different E-Mail 50AF3 0— yrt--—Iq C
from the Owner listed above) State or County license
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION CfEN 1AWAFORMATif�N.
DESIGNER/ENGINEER: _Not Applic a MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City' State: City: State:
Zip: Phone Zip: P ne•
FEE SIMPLE TITLE HOLDS _Not Applicable BONDING CO PANY: 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 thepermit holder to build the subject structure
which is in conflict with any applicable Horne 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,l 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
uWARN/IIG TO OWNER: YOUR FAILURE TO RECORD A N0110E OF COMMENCEMENT NAY RESULT IN YOUR PAYING
TWICE FOR il11PROVENENTS TO YOUR PROPERTY. A NOTICE OF CONNENCENENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FMST INSPECTION. IF YOU IINTIffinrT0 OBTAIN FWANCII G, CONSULT
WffH YOUR LENDEOR AN ATTORNEY BEFORE RECORDIING YOUR NOTICE O ENT.-
4.101� I XZ%-- JJ/(
Sign ture of Owner/A Le contractor as Agent for Own S nature of Contract r/License Holder
STATE OF FLOR - STATE OF COUNTY OF ORI
COUNTY OF
The fc�Fgoin Yinstr nt s acknowledg before me The rgoing in e t as acknowledgelbefore me
this of 20 b this day of 20 t by
'f G�h INA t�s
Name of person making statement--JName of person making statef4nt.
Personally Known OR Produced Identification 4// Personally Known ✓®RR Produced Identification
Type of Identificag{gn�J Type of Identification
Produced Produced
( re o ota 411% greooaryu01
ROBERT ETINGOFF ROBEI,� INGOFF
Commission No. MYCOIfON#GGI99237 Commission No. MYCO #GG199237
EXPIRES:April 30,2022 EXPIRES:April 30,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19