HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:- ��a� Permit Number: a4z:�a
RECEIVE®
Building Permit Application JAN 2 9 2020
Planning and Development Services
Building and Code Regulation Division ST. Lucie County,
2300 Virginia Avenue,Fort Pierce FL 34982 / Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial t/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Q d�
Address:_l 0(2)LILl C�c+l�,c� �c �U e� y "�{ q6(..
Legal Description:
Property Tax ID#: Li50 a, -0(- Lot No.
Site Plan Name: Block No.
Project Name: 1_)`�G Co. Per Z
Setbacks Front Back: Right Side: Left Side:
- �z �{IP+4��tI .cr.,�:.r,ra xi�s`�x `�.Q �, 'k'-�'t'.; a a�. # a '. y t_ � t '� �; ✓ '�_�R� r-s`�
_J.zi F __ s s! T I.F[S*n—�"+�.1-F•e rr-.a �}r-,:�-t+,-4.
itiona war to e e orme un er t is permit-c ec a appy:
HVAC �Gas Tank ❑Gas Piping _Shutters Windows/Do��„
Electric �Plumbing Sprinklers �Generator �Roof -
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ [.C�GO •G _) Utilities,
0Septic Building Height:
�OWi�JER LE� S .s� A tdack 1Cg Y } Fiy1; i �1. N 1'RA y. t 3Jx�r§. z r C;L ern7r 3 � v
Name M,1 Ckae,L
Address: I Ob 4`4 ()c e_'.r-fn r ejnat A 6(, Company:,f-1-C,n
City:Ser\S e n &C.ar_4. State: Address: i,ZH U 1 -75,Tf 1
Zip Code: 3`-Lnv 5-) Fax: City: I_.0,�ffi k nti ec--(01--_ State:_E_`-
PhoneZipCode:3SL41 9-- Fax: 41 _"��S•�fUS
E-Mail: Phone No. 5;_C,'I
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 0 Cr) C,C)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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sUP ]{ 1lU¢1'A Q, SRI IQNLIE11 LAV1liyfF(?RMATIO,N7 t x < $ �� - �s"`•`
I��:r
DESIGNERJENGINEfR: Not Applicable MORTGAGE COMPANY: Nat Applicable
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: y Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 Owner's 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_pP+ercordingi your Notice of Commencement.
s
_Signature of Owner/Lessee/Agentof Contractor/License Holder
STATE j1F-F1_a91DA,,,, STATE OF FLO�1,D r�
COU TY OF t+! I( "�jlr1 COUNTY OF 8500 '&,!1 C.t'I
e fo Q ng instrume t was acknowledges efore me The forgoing instrument was acknowledged before me
this "may of 2a '�by this day of s 20Q by
I ,
me of person.acknowl ) (Name of person acknowledging)
(Signat of Notary Publi tate of Florida) —�� (Signa re of Nota Pub�®R
te of Florida)
Perso ae OR Pro ced Id n fication�A Personally Known roduced identification
Type of Identification Produced �-- �I .. Type of Identification Produced
Commission N�O� a (5%R&LGROGG Commission No. (Seal)
-" =•••,4 ANGELAYOUNG
* *MY coMMISSION#GG 080413 �otP s�rn
# _ MY GOMMiSSI4N#FF R51069
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� Nor `e EXPIRMA ri112.2020
Revised 07/15/2014 9-ort to' Bonded Tiau Budget Nobq Se COS o
s o�0 9
f f� Bonded Thru Budget Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS