HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I O
® _ RECEIVED
Building Permit Application
Planning and Development Services NOV 2 5 2019
Building and Code Regulation Division
ermitti
2300 Virginia Avenue,Fort Pierce FL 34982 !facii e Count Department
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED;IMPROUEIVIENTLOCATION` f
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Address: `t/d' Eu"PEW LMS
Legal Description: PAU)1 we- 61h l�°Ll. (r LUl- q b. la AC) CDQ a 3bl- 1460
Property Tax ID#: 7�? qL-503- O/q?- Wo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
20 Ak&
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CONSTRiJCTIFON INFORMATION' s° _
Additional work to e e orme under this permit-check a appy:
1_1HVAC D—Gas Tank []Gas Piping Shutters QWindows
Doors
11 Electric F�Plumbing Sprinklers _ enerator
1X Roof Wil Roof pitch
Total Sq. Ft of Construction: 3'3L_ SFt.of First Floor:
Cost of Construction:$ I7J. `�1 S Utilities:n Sewer Septic Building Height: -
OW,NERj LESSEE
,yCONTR'AC�TO'R
Name_..,IWMVI-Y SC:II0(y1( t7? /` Name:
Address:_ Z11? Company:
City: EbZT OZegG!_ State: L Address:Jr'oo/ 5. �S 'YY1EV�72 Cir(LCI�
Zip Code: _'5qJ02 Fax: City: A&L 51- Lucrtc State:_F—L
Phone No. <5/6- (?b— nqz," Zip Code: Ziyg5_�i Fax: ZZa-339-955Y
E-Mail: Phone No. -7h 7 3- 73-3 �55�
Fill in fee simple Title Holder on next page(if different E-Mail: -I- c9 A)7:5 12
from the Owner listed above) tate or ounty License:
11 value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SrUPF,LEMENTA�CQNSTRUCTION �I,EN�LAUU INFORMATION M � � �x� �� Y s:
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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
commencing-wopk or recordinaur Notice of Commencement.
nature of Own-&/LesseeJContractor as A for Owner Signature of Contractor/LiAdse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF =fir COUNTY OF _r 1 I_P.0 C
Thefor$oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this o9i day of ti l7UEyV!&t 20/1 by this;./ day of &20.2k,&2 20_9 by
Name of person making statemeng Name of person making statement
Personally Known U _OR Produced Identification Personally Known_ ( OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign ,ure of Notary Public- ate of Florida) (5ignat a of Notary ublic- ate of Florida)
r Fu DENISE<.E}AAY z4i�.Pue� DENISE LE
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Commission No.
6.07737 ���= �c�nMiSSION#GGa Zfommission No. L�b'?Z�°3'Jlo ' �*MycoDNIMiSSiON# 77376
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17