HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: P�, `�� 2.�\Q Permit Number: I I o10
RECEIVED
Building Permit Application
Planning and Development Services DEC 0 3 2019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Si. Lucie County, Permitting J
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P12QPQSED IMPROVEMEfVTrLOCATI,GIN
Address: JC`7�Q -� �dC S fY1 1 m
Legal Description:
Property Tax ID#: �J q -:50�- 000 g CD4 --.3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right-Side: Left Side:
DETAILED DESCRIPTION QEF WORK
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CQ}NSTRCICTION INFORMATION
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Additional work o be erformed under this perms -c ec a appy:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
10 Electric Plumbing Sprinklers FIGenerator F] Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$( ,rzP, UtilitiesSewer Septic Building Height:
OWNER/LESSEE } ` ,;:y_ CONTRACTOR
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Name. � � OS Ae— Name: P_
Address: 6Q(o se l.. O_Ma!S{_ F-N e-- Company: ,S 6_ SGV rl C_ c
City: &V 1 L, GL.P. State: h- Address:6 0O1 a l ga nd P / f�-e_Zip Code:;meq,F3 Fax: City:�Coel r 1.2rC-0- State:
Phone No. Zip Code: 3�tq e-2- Fax:Z7�L 40- 13 59
E-Mail: Phone No. "7-12 4:9-9 - 9l 0(C4
Fill in fee simple Title Holder on next page(if different E-Mail: 0,6k
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from the Owner listed above) State or County License: ike- o cam®
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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.
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 or an attorney before
commencing work or recording our Notice of Commencement.
Sign ure of Owner/Lessee�Con
_a
s Ag nt for Owner Signature of Contractor/Lice`ns older
STATE OF FLORI�q STATE OF FLORIDA
COUNTY OF `g+, �Lt COUNTY OF St Lucie
The for�ing ins ment wa acknowledged before me The for ing ins Went wa acknowledged before me
this day of C(l _,20by this day of C 20A by
I Lox- I ?CLA 1 LAI_
Name of person making statement. Name of person making statement.
Personally Known X OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Signature of otary Public-St tri.da) STACEY GARCIA (Sig ture of N ary Public-S �n a
MY COMMISSION#GG 08 0 STACEY GARCIA
-1c �g��L EXPIRES:May 16,202 GGoaSsao ? MY C MMISSION#GG 08
Commission No. , eaY fission No.
ThN Public U •;- �$e 'APIRES:May 16 2021
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��„ Bonded Thru Notary Pubik U
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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