HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: /2- Za— J `XO Permit Number:
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Building Permit Applicatio DEC 2 6 2019
Planning and Development Services ST. Lucie Counter Permitting
Building and Code Regulation Division g
2300 Virginia Avenue,Fort Pierce.FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR@PQSED INPRNA.EME�NT LOCATIC+?N:
Address: /2 q 7 51 �1o4T�7 ,.���.� /Ci ve. ,�� ��rrt., �r�c�i 3�e5V7
Legal Description: - s)Prj e5 4,11 Q//d �L CoA A-,4ci S&c Z1-3>_y;�
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Property Tax ID#: Lot No. /t. Z
Site Plan Name: / Block No.
Project Name:///,4NC!2 /-c Z/r
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION =001 u
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COST'�U'CTI`�N I�N��ORM�4 IQN:
;A ditiQnaWorktobepertormecluncler.this permit-check all that appy:
} _Mech'�nical _Gas Tank _Gas Piping _Shutters _Wi ws/Doors
Pi ch
a Ele`ctTic _Plumbing _Sprinklers _Generator _ oof y��2 � /
Tot'jrsS :°Ft°of Construction: Sq. Ft. of First'Floor: Z(o Ll J-
Cost of Construction:.$. Utilities: —Sewer —Septic Building Height:
V&WRRLE=.S�SEE: 1.
CONTRACTOR:
Name lylq-i ccs z,G -eel4 1,r , Name:C'
Address: f Z1/ 7ci .S' �n.� ivc. /O� Company:,P 7�1-,o,l4S a
City: Jery+4.. ly��ti State:�C- Addrespps:3�/2S J(- ;;TTy �*
Zip Code:3�`5S Fax: City: �iy, Ci2`7 State
Phone No. Zip Code:3g9gl ' Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail Cvc41 r?,-/•�o'10/tiS
from the Owner listed above) State or County License CG C cyz-37d�
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Evalue of construction is 2500 or.more,a RECORDED Notice of Commencement is required.
L1PPLfMEN A CQNSTR+UC'TI�N Ll �N LAW I ;�F�R+MATIG�N:
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 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 N e of Commencement must be recorded and posted on the jobsite
before the fi in ectio . If you ' nd to obtain financing, consult i end or an att ney before
commenc' o ordin ur Notice of Commencement.
ure of ner/Lessee/Contractor as Agent for Owner ignature ontractor/License Holder
STATE.OF FLORIDA STATE OF FLORID
COUNTY OF. COUNTY Or
F i p= (��N _
The forgoing instrument was acknowledged before me The forgoing instrument was gcknowledged before g'
this day of 20_ by this a day of 2015 by
Name of person making statement. Name of person making statement.
:.
Personally Known OR Produced Identification Personally Known �ced Identificat g=
Type of Identification Type of Identification.
Produced Produced
(Signature of Notary Public-State of Florida) (S' ature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING- SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.