HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ` q Permit Number:
RECEIVED i.
NOV 13, 1019
Building Permit ApplicationeFmlling Department.
Planning and Development Services
St, Lucie County
Building and Code Regulation Division
2300 Virginia.Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
FRAU' OSED IN 'ROUEME T LOCA 1 •N;
Address: GL d i d M iy'2y' �Y. �. P,-ev'c'e ,
u / a7�
Legal Description: 2-6 3! -!d Turd d(r f of 490 F f� dt-9 M. 0 rf ®f GOV Lp f
L- C_ E 0 F E R/ Of FJF6 FT - C-3 2)
Property Tax lD#: � rV - 1413 --0003-000-3lqo0"3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I
j DE 1LED DESCRIPTION OF U1/ORK;
1�e Ike 10d-S SevvlCe 14/ Vv , /fie f-ev^ cd 11 a ti d wedgy-N-Voroo 1� 941e ''CIA
CcV'r_g6 �redlis > C&1j_rtNf p4wp iS Lvo av4WJ , AlewlydPiet -4obegod
C1 Vit. Jas. 57o_ Q I— OV -d 019
C0 STRUCTION INFORMAT,GO,N:
Additional w6BE06Ff6ri-ried under tis permit–check all that appy:
—Mechanical _Gas Tank _Gas Piping _Shutters, _Windows/Doors
1//Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
u
Cost of Construction:$ 2,N0 Utilities: —Sewer —Septic Building Height:
OWNERJLE�SSEE: CONTRACTOR:
Name .5 sd I'1 P i Pq e5' Name: pole vl
Address: 360 S: 3:mj,`j14 Diver Pw Company: P? ,be. fec-fv"i c i 4oC-
City: A-Gr} P,`e&rce State: FL Address: P O- 6 o K
Zip Code:. $Z Fax: City: G��r`C y'C e— State': r L
Phone No. (�j g0V Zip Code: �/��Ll 7 `� Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License UU (5'3 6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU PLEMENTAL CONST UC IN, LIEN NNW FORMATION:
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
commencing work or recording our Notice of Commencement.
Sid ature of Owner/Lessee/Agent Signature of Contractor/Licens Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF �� LC.I c -
The forgoing instrunpent was acknowledge efore me The forgping instrumen was a.knowledged before me
this J&day of W 20 by this ay of 20� by
' ��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Sta e o orida) (Signature of NotaryPublic- tate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
ELLENAUGHN Commission No. ELLEN (NOGN
Commission No. ;� �':State of Fliipd `H
*Notary Public
=' Commission #GG 270079 ?z° State of rloridd,Notdry Public
My Commission Expires
_ e Corr>nlid9ion # OG 270079
Octo er 22, 20 �ctob®r 22, 022
REVIEWS FRONT ZONI G R PLANS VEGE VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED -
ev. /2014