HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BEE�COMPL. _D FOR APPLICATION TO BE ACCEPTED s
Date: /' //D • % Permit Number:(
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
JUL 16 2019
Permitting Department
St. Lucie C nty, FL
Residential
PERMIT APPLICATION FOR: /t2 as/Le �V M t -
Address:
Legal Description: Iv C.jL 1LJ 1 ZOUM IW 11 11�-
1�
Property Tax lD#: r�'a1 -SD1r �, "10 -
Site Plan Name: 1 \O' I.1�y-DS 4;0
Project Name:
Setbacks Front 1 0 t/_ ( 1 IL Back: a Right Side: O Left Side: IV
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Lot No.
Block No.
JAUU I LIU[IdI WVIR LV UC PUI IUI IIICU UI IUCI LI IIJ IJCIII IIL— L.IIM& OR LIIdL dlilllyl
"Mechanical GGaasTank l Gas Piping _Shutters Windows/Doors
✓Electric "Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �, 5�D Utilities: _Sewer —Septic Building Height:
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dDONTRACTOR
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Name JarheS C SA-vio
Name, Korlialk
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Address: I003 NeN-teS (7
Company: ✓
City: coeln Cin State:
Zip Code: /3/���11aS�-F�Iax: ""'
Phone No. (A- Solt ^ 1 7
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Address: t)S ILI91
City: E -Y (Gt'� State: h.
Zip Code: 39 aS ( Fax:
Phone No GOD
E-Mail:
Fill Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 0-I11Ch0YJOL0n n1DY�11P hDY)Yl�
State or County License 1-1♦-)10113-7
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S11PPLfIVIENTALCONSTRUCrJON`LIEN'
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DESIGNER/ENGINEER:. _
Name:,,,
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
_ Not Applicable
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER_:' _Not
Name:
Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
Zip: 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,
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 recordi ur Notice of Commencement.
Signature bf Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
I,uGe
STATE OF FLORIDA ( . G�
J
COUNTY OF
COUNTY OF
The f ��tng instru ent as acknowledg d efore me
this MCIv of 20Bby
Th mg instr t�Tn!en1�wa��s acknowledged before me
this 'tlay of_IJl�J 20 by
Ronal �3�Q�h
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(Name of person acknowlecl Ong)
(Name of person acknowledging)
(Sign of Notary Public- tate of Florida)
(Signare of Notary Public- State of Florida )
V
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
•
%' /� ov Notary Public Elate of Florida
J5r N State
Commission No
J^^y Julird:
I I My Commission GG 257641
ommission No.l.�V+ +P I Ju 6®e i
a I myc .
tvo /5 2tlGS2 287641
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REVIEWS
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PLANS
VEGETATION
SEATURTLE _
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
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