HomeMy WebLinkAboutBuilding Permit Application�.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! 7rr/�'_�� Permit Number:
C nw
" LRECEIVED
EC 12 2019
�- - Building Permit Applicie
County, Permitting
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 Residential
PERM IT APPLICATION FOR:
*PROP;OSED INPROVEMENT LOCATION. '
Address: e 144 /�
Legal Description: &n4,-72P,
Property Tax ID #: 6a` -- m —%44 Lot No._ Af
Site Plan Name: Block No. Yoe —
Project Name:
i �q�® O
Setbacks Front - Back: � Right Side: •zd Left Side:
.DETAILED• DEkfoTION'`OF 1NORK
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�> v /r e S / e- EG
CONSTRUCTION`NFORIVlATION';
?�\?��'src av�°s ="
fiona wor to a pe orme under this permit — cneCK all tat apply:
_Mechanical _ Gas Tank —Gas Piping _-ters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
v
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
' OWNER/LESSEE: s -
��"
CONTRACTOR =a
.
Name�4,ria- �pEV
Name -.'-
Address: /OJ'
City: Rz '&� State:
Address:�l//G�,Q�d+�QO�E_ .
City: %�17t� State:'��
Zip Code:70/-Vyl Faax-::
Phone No. �r.�0�^y /�/%3
Zip Code: 7W,�� Fax:
E-Mail:
Phone No!yi W4,—?A.0a
Fill in fee simple Title Holder on next page ( if different
E-Mail r�
State or County License aef3
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. -7 �j _
b- ( — C�'717-5
SUPPLEMENTAL CONSTRUCTI ON�-L'IEN¢,,LAW,'INFORMATION. •.,.�M.,,.. ,,:;.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:i�i¢S,, ir//�� S
_
Name:
Addres;: 6 -44i;74-
Address:
City:// F 4 State:
City: State:
Zip: 2.M67 Phone97e2no2k;Z .able
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 such
prohibit
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
commencingwork or recordingour Ice of Commencement.
�Not
Signature of Contrador/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORS,)FLORIDA
COUNTY OF N Ly c'�
COUNTY OF 'S k. L,3 e %�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this \ day of 'fltc= 20 19 by
this ��±. day of IDI ec 20A!� by
N"No-allov-b �(i1b�r}
-Y �%"htNAs N-.l bw
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
(Signature of Nota Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of R tification
Type of Identification
Produced ` 10 t—
Produced
IE GNENg
Commission No. O�NpGG 022023
NppdpRIE G�N,E,�N2B 43
Commission N �C1,' MIg510N><pca 20
:�C� ""' "'•. h1Y 00 r 18, 2020
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�SEATURTLE
REVIEWS
FRO
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SUPERVISOR
PLANS
VE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014