HomeMy WebLinkAboutBuilding Permit Application f
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: aooz- ocooj
Ly RECEIVED
ego
Building Permit Application FEB 2 4 2020
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: .29929t.fto a r- �)r_. iriasm
Le al Descrip ion. V Mo1 rn t V _ Jr L
Abn Sq N -Dml e E zoq,54 Ft IRS QOCko031»' sec� n3 i-
PrUo�e �19"VID#: ,,pp ,,rrte� c- t -LAI ! I�11'-�I�' t�� ' O Q Lot No. ca
Site Plan Name:_ rLl... ro O F `"1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�.C(no (�e 'exMiriq Ser iCr in r�.tul troop CLOv�n ro r-ooF OLQ-C(C .
1�5W l I NEW iA \� I( X U ff) T\1 rY�to l
n
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
DElectric 0 Plumbing Sprinklers Generator ® Roof ® Roof pitch
Total Sq. Ft of Construction: -1 ( c) S . Ft. of First Floor:
Cost of Construction:$ l J , �() Utilities: Sewer F]Septic Building Height: I �J�r
OWNERAESSEE: CONTRACTOR:
Name Jovor. Name:
Address::ai Company: O'01H V i
City: SC�(c t Clair Shows Stater Address: 3 l 5 E '1 I
Zip Code: o Fax: City: Pat t sort . WC, State: FL
Phone No o� �� - Zip Code:�y Lc5� Fax:
E-Mail:jplcJ jn�1 (D ao)� .Coro PhoneNJ6r00r(n%3,ndwoKrFr60kMc0Q
. 71-1 ��L , '-14 (03
rf
Fill in fee simple Title Holder onext page (if different E-Mail: I�
from the Owner listed above) State or County License. CCC- - I S30 I 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATlON
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: � Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _ of 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 r or recording our Notice of Commencement.
AOlkl� 131WA�
Signature of wner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF a LUC1 6—
The
The forgo ng instrum IgtTnTas acl<nowledgfore me The forgoing instrument was acknowledged before me
this day of o 20 y this�day of f5�(iJt.c/cc�L1 20 2& by
v)Wn u) W55
Name of person making statementName of per n making statement
Personally Known OR Produced Identification ✓/ Personally Known V� OR Produced Identification
Type of Identific tion Type of Identification
Produced Produced
9X aQ
-2_ 1
(Signature of Notary Public-State of Florida) (SignatEoftary t 1 -S� a e o F Irl aou lac tate ofFloridaDeena M Sabella
Commissi 1YPU KAREN S. NIElf CommisMy Commission GG 2291ol�Se
_ tate o Florida-Notary Public pares 42022
Commission # GG 207484
OF F�° MY Commission Expires
une 12, 2022
REVIEWS I-RUN I PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17