HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AD �/ Iq Permit Numb O` W" 0 M011 F%
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OCT 2 4 2019
Building Permit Application
Planning and Development Services Permitting [department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:.(772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 505 S_ i '1 _ q
Legal Description: s h- S
CIO f�t r C 33b
Property Tax ID#: '5y0kao(' OOH- Lot No.
Site Plan Name: Block No.
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Project Name: �(\c�'!C' Ct G�
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under t -checkispermit a appy:
HVAC 'InGas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: [I �j �1,� S Ft. of First Floor:
Cost of Construction:$�v [ LA O Ii w UtilitiesliSewer Septic Building Height:
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Name 0 y ckCC-5 Name:
Address: Jam[ -za6ip„n%mmi, Company:Sp\oL<- & Gti
City:VT� P� State:[ Address: l(oO 5r,a�1 wood
Zip Code: 3 q %D-• Fax: ��11 City: fib- P i P�Ce State:FL�
Phone No. < <pC� Io3 "�+�'599 Zip Code: Fax: -1'7--Y(o(a- 7937
E-Mail: Phone No.-772- ufv�(�L(Q(o3
Fill in fee simple Title Holder on next page(if different E-Mail: Sn�cz�e ne,- Ca I"
from the Owner listed above) State or County License: G O
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
PLEA 1EIA CO`NRUUTH LIEIL�i4;U1J I�tFOM-AT d1�IVh Y
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
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:
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 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
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commencing work or recording our Notice of Commencement.
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Signature of Owner/L e/Contractor as Agent for Owner Signature of Contrac ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF G-2
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of C-6 6ee- 20 Of by this day of -(��.pl 20 19 by
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Name of perso making statement Name of person making statement
Personally Known OR Produced Identification Personally Known Z OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(S' nature of Notary Public-S nature of Notary Pu ic-S e o F o i%01 a
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� Notary Public State of Florid 3�1Z to ublic State of Florida
Commission No. '✓� (21 ( Sarah Blystone Co mission No NOG
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My Commission GG 361295 arch Blystone
ja Expires Os/2412023 1,00ExpCe 06/24/20ommisin23 361295
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
.COMPLETED
Rev.8/2/17