HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED may)IDn
Date: C� Permit Numbe
�-16 ai'31
= JAN 3 2020
bY ♦ M
Building Permit AppliCPeoAl itiin
Planning and Development ServicesSt. � Department
Building and Code Regulation Division Lucie County, �L
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: h 14, Y-�-
Address: 676.E r07C�/,-;ob rUbf 76 /" ,Qdr 0A I Ca 0/ 'YV X-2-
Legal
-2Legal Description:al octc 3 tot''
Property Tax ID#: c?yls" '70.6-O 0.5(2 — Od O—J— Lot No. _
Site Plan Name: _�!� Block No._
Project Name: dam *n
Setbacks Front Back: Right Side: Left Side:
i4dW t ot oi?t 4 cc . 1�,... � a f�a.�trt wS �{o w Ove.,-- 67K/ .4 e c
4L Aer
MAd d itonona wor PoeNpoppAorlRedn er t is permit—c ec a tat app y:
_Mechanical _Gas Tank _Gas Piping -jShutters `Windows/Doors
_Electric _Plumbing _Sprinklers `Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
p4P0
Cost of Construction:$ 9'old Utilities: —Sewer _Septic Building Height:
Name Mar;^h k Name:' tit C
Address: 67&,z O)C/k;r:Jon Te" Company:CaafXf!f cS�v GiJQ^ rf v '
City: 162--l JA Lvcj r State:F1 Address: 2 ie- gQ1yAf
Zip Code: -3 Mr2 Fax: City: State:
Phone No. � &. /-'As t- �1' Zip Code:.-?/-/ V4 Fax:222• Vf,l
E-Mail: Phone No 72,2
Fill in fee simple Title Holder on next page if different E-Mail f1JH?, sZkv i I C c� IA,4ieQ• C4h�
from the Owner listed above) State or County License,'C�'13115/.S~At�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: __,.V Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip' ,Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _)i[Not Applicable BONDING COMPANY: k/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 anr ri
otheon=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`ah attorney before
commencing work or recording our Notice of Commencement.
Signature of OvJ er/Lessee/Contractor as Agent for Owner Signature of ractor/License Holder
STATE OF FLORIDA STATE OF FLO
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing ins ent was acknowledged before me
this day of 2Q by this day of °+ 20.V, by
A rn � tn�
Name of per making statement. Name ofperso making statement.
Personally Known OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Type of Identification
Produced Produced
AL �1,vn a6L4"
a- �A _ .
Signature of i - (Signature of N ry Public-State of Flori a)
,•�o<:rYPYq�c; AUDREYB.HUMPHREY
Commission No. OMAdISSI �G 300817 Commission No. :2i?"?q'r•. AUDREYB.H(SJl Q
EY
EXPIRES:March 6,2023 =*: a= MY COMMISSION#�GG 300817
FOFf�Q;' Ronde r ,. ;} _�� �:o
F'irF:n` nded Thru Notary Pub! .1 n ":ricers I.
REVIEWS FRONT ZONING. .SUPERVISOR PLANS V E G T_1'1O1 Tl='�' OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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