HomeMy WebLinkAbout1911-0243 (2) Noy 1219,04:16p FTI. 772-340-7677 PA
ALL APPLICAII, E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit N=4er-1.9—U�
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Building Permit Application NOV 12 2019
Planning and Development Services
Building and Code Regulation Division .-Permitting Department
2.300 Virginic Avenue,Fort Pierce FL 34982 Atidlg.L� county, FL
Phone:(772)4621-1553 Fax:(772)462-1578 Commercial — 111,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: 1 EGA
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Ch cGly-
CONSTRUC71ON INFORMATION:
Additional work tobedeffOrme d under this permit-check ail t=apply:
D—HVAC n Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction- Sq.Ft.of First Floor:
Cost of Construction:$ t Utilities-17 Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name -1, , - -j--. L-11' I
Name:
Address: 6 ' Company 1-_:::_i1-6L--'C.
City: State: Addren
M 5_i!-
Zip Code: 2_44!�ff�j Fax-7-72--�VL,7�_-?) City: State:-C—L
Phone N o. -Z.�— .3 Y V ,'g Zip Code: �qul Fax:-77,0..--3,'l 0 -74-J )
E-Mail:. C.6y1 Phone No. -7 7-- 3 b-A
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License;Le-
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required-
Nov 1219,04:16p FTL 772-340-7677 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: / Not Applicable MORTGAGE COMPANY: Not Applicable
Name: T Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: -4L Not Applicable BONDING COMPANY: KNot 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 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 o an attorney b7fore
commencing wo or recording VoMr Notice of Commencement.
D�v Ily—
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ature' 0, er/Lessee/Contractor as Agent for Owner SignC of Contr�e or nse Holder
STATE OF FLORIDA C / STATE OF FLORI
COUNTY OF COUNTY OF .2� Li'cl(e- l
i
The forgoing instrument was acknowledged before me The forgoing instrument was/acknowledged before me
this t ra�y of k e ve , 20,, by this/�a'ay of �a L�-o'K�i 20 f by
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I ,14 it�L-r 1,164 C4'L'1,.� � 441sT. L' na&A��r�,
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(Name Rffiiirsdn acknowledging) (Naperson acknowledging)
n
!( ' nature of N15f ry Public-State of Florida J (Signature of Notaryublic-State of Florida)
Personale ification Personally Known OR Produced Identification
Type of DO Type of Identificati n Produced
r.•:�• =: MY CCMMISSlO:�FP9
es EX?IAES:Febru
Commi u,,Tw
avy D
� _ _ v'wUrid u� Commission 1lpL�uo�D(�al
MY COMMS FF
-= EXPIRES:Fabrumy 22.2MG
3od��N NQUOY
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS