HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I FO MUST BE COM-''.__ 'ED FOR APPLICATION TO BE ACCEPTED
Date;
��p Permit Number:
� �,p,
MAR 3 0 2020
Building Permit Application ST. Lucie County, Permitting
Planning and Development Services
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982V/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: ! /U a
Legal Description
Property Tax ID#: XIL45 9�0l— 001z^ edo— lel, Lot No.
Site Plan Name:
Project Name:
Front—c7-O_ Back: �30 Right SiderLeft Side: 2a 7
Setbacks
h
Block No. G.4
LMechanical _ Gas Tank _ Gas Piping _ Shutters L�hlfndews/Doors S:&V
✓Electfic _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: R6y
Cosfof:Construction;_$..,x,"Do-. Utilities: _Sewer V!reptic Building Height:
J.IV
Name �o�ii /�u-c�
b
Name: • ... CIo e .�.= = �1c
�Tusr�
Address- /f?A6 /%!k �� Gvi
Company:
City: ze,State: _117e—Address:
Zip Code: Fax:
city:
State: !Z
Phone No. C'9S = -q�014
Zip Code: ySrf7 Fax:
Phone No —!.?/D
E-Mail:
r
E-Mail C-OWA o
ou co
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License C6cL.�!
9 'XA 9
d
if value of construction is 2500 or more, a RECORDED Notice of Commencement is require .
i . k. Nt si 2 r •. w s w e.3. .0 ✓. 7 Zy l A !e�'— .�^
SUPPL M N AL 011�TRl1CTIt5�11Mt IA"''041MV,MA7I01
W''•ivli3�"—L3f.H.vkhaE3.i•.otY
x'.i. rT
, �` g_ 77��,
.1'..t%k �ai•r a�`rvJ..JUJJy'fci' }i`✓�4p+ �:h �i'•445 t'.�i _
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zi Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zi Phone:
City:
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, i
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 or reco�dins your Notice of Commencement.
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractor/License Holder
STATE OF FLORIDA�
STATE OF FLORIDA-. I // ,, ,,
COUNTY C ��. f:
COUNTY C 6JC V • !
The r oing instrument w acknowledged efore me
The f oing instru�r�e y s acknowledged before me
this day of 2Q by
this day of iVlf1� 26W by
(Name of nowledging )
(Name of of per�owledging)
L,_
person ac
' i
(Signature of Notary Public- State of Florida)
(Signatu a of Notary Public State of Florida )
Personally Known V/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced —
Produced��.
IELSEN
of Florida-
N '4 =ote1'Publi
"n 6KAR
NNIESNState
tate ofCommission
CommissionNo. -Notary
ssion#�7484
3 r, `pT; 'my Commission Expires
Public•
_ n �c commission # GG 20748,: U,
° M commission
""r Y
.iune 1'L, 202?
����"° mission Ez pir .
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEATURTLE
COUNTER
REVIEW -
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/ZU14