HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02 Permit Number: s ; t-
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Building Permit Applica ion FEB 5 2020
Planning and Development Services PermittingDepartment :
Building and Code Regulation Division St. Lucie CQUrit F
2300 Virginia Avenue,Fort Pierce FL 34982 y, L
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi entla
PERMIT APPLICATION FOR:
Address: V�-
Legal Description: FIA �ct A I Ain (3n
eAr�,cn S
Property Tax ID.#: Zq f7 s� 7o 3- o o l 6—coo — cL Lot No. +
Site Plan Name: 14 Block No. 33
Project Name: .
Setbacks Front Back: 'b Right Side: Left Side:�O _
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping )Shutters —Windows/Doors
—Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ p,s70 Utilities: _Sewer _Septic Building Height:
Namea r -`
>d- .: -�..._...._ Name:
Address: U;a an +1�✓ �i.1�'�'
Comp y `CpAJ);i / cS�v Ci/p Y
City:_t-T i',e r C= stater L Address.
Zip Code: y`9' .' ,Fax:" Jlil�''": t City: d-;t✓Cc stat;--
Phone No. 116s-, 3637 6 � �'G � -
Zip Code:� �, Fax:2?2- V61 Xb S-
E-Mail: A Phone No 7.7.2-J? 611- oZ//f
Fill in fee simple Title Holder on next page( if different E-Mail TOf'+'), Sky 1 L to v4heo CoAl
from the Owner listed above) State or County License dce-1.3 /S/S08
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: -)t 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 Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you i our
to obtain financing, consult with lender or an attorney before o
commend work or recording yur Notice of Commencement.
Signature of Owner-/Lesfee/Contractor as Agent for Owner '75�fignature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgedJ?efore me The forgoing instrumenhwas acknowledged before me
this_Z�day of 51 J-, 20by this day of 2 by
Name of person making statement. Name of person making statement.
Personally Known "�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of ary-Public-State of Florida (J ((Signature of qVary Public-State
of Florida
JD B •
Commission N P!yN- ,%. At REY ..Nww Up*'i
11 IONMIG-1100817
Commis REYB.H
*817 MY
ISSION#GG 30817
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EXPIRES.Liarch 6,
8i_2029
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED,
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