HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' ' Permit Number:
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Building Permit Application
Planning and Development Services FEB 2 4 2020
Building and Code Regulation Division ST. Lucie County,2300 Virginia Avenue, Fort Pierce FL 34982 P itting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 01F
PROPOSED IMPROVEMENT LOCATION: hL
Address: A0 Ne
Legal Descri tion:QE- IC) of 91I0-37-41 Frc�rn INr aFi'�l ll (.aF 2 I(Um E fZlw FEC IZuW EFfLC,Tsr� nl LI
a.0a Ff -}o ppb, rNCONI' azo �, TO -Ly 170." t ry % iv�tt£ .7#4F-%W SWAY A cwr/L CuNc- TO rt, (�
Dro 11 Min lo 696 214(61 ')'i.41 Fi Tb PolPT,'IF1 u 3S Fl Mf L,111 ElAiI`I 117.131 N TO rats(QUAL-958:iiaf- M)
Property Tax ID#: Lot No. Z
Site Plan Name:_ S L J0`0' na e.n P=P - Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION Of WORK:
�.er�c�v�. exi�tin Shinc��t roc�� d.U�sr r('C1rs� I�C-. Ir��fio�.�1 Y1t�
I ar\cLk( Sews Irv��� I rQc .
CONSTRUCTION INFORMATION:
Additional wor to a er orme under this permit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers I GeneratorLLQ Roof - ��2 Roof pitch
Total Sq. Ft of Construction: t coC)O S . Ft. of First Floor:
Cost of Construction: $ ,� � Utilities:CnSewer Septic Building Height:
1
OWNERAESSEE: CONTRACTOR:
Name_MZ Iry(1 ► 9jmcLC%f-\C 44ex-\ Name:
Address:026 Company:J ` 6\r-� a
City: State: Add ress:�01 SC L12 (s,S(,t C�r
Zip Code: -7 Fax: City: Pu(t . &+. L(-A( ( e State: FL
Phone No. 1 (�r) Zip Code: 2J95-2- Fax:
E-Mail:M j r✓1 1p be,lJ1&6" n,b� Phone No. :Z-7,)L - O 3Y 7&o 3
Fill in fee simple Title Holder on next page (if different E-Mail: ,L^C�'l�►
from the Owner listed above) State or County License: CCC - I 33CW(G .
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
ai
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 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 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 w rk or recording our Notice of Commencement.
�A/s rI,
Signature Owner/Lessee/Contractor as Agent for Owner Signature of C tractor/License Holder
STATE OF FLORIDAL ' " STATE OF FLORIDA
COUNTY OF 1, • L l'I(�I� COUNTY OF C ti � E
The forgTing instruptent viLas acknowledge before me The for oing instrument was acknowledged before me
this day of 2a by this day of Ttbl.1ranA 20)Q by
o N NI eu�;s Bohn 11)BCS5
Name of person making statement Name of perso,p making statement
Personally Known OR Produced Identification Personally Known l/ OR Produced Identification
Type of IdentificaUion Type of Identification
Produced Produced
J A M.M- 4m6t�
(Sign atu\r'e-J Notaj Public-State of Florida) (Signature of N a
n� a� My Commission GG 229100
Commission No. KAREN $Shl�LSEN Commission No. 4�aNO Expiresosr14/202?Seal)
=o' < ,State of Florida Notary Public
•= Commission # GG 207484
My Commission Expires
u
REVIEWSO I G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17