HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE C ,`LETED FOR APPLICATION TO BE ACCEPT kj�
Date: -+"\+ 1-7 Permit Number: 1 "�
RECEIVED -
Building Permit ApplicationAUG 0 2 2019-
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: >,�tnd GY�C •
Address: -7 5 0ll
Legal Description: 51,11 ►��
Property Tax ID#: 3S_3 2- ( 3 -3 Lot No.
Site Plan Name: Block No.
Project Name: e r V ' iL 10,
Setbacks Front Back: Right Side: Left Side:
0
Additional work to be pertorme un er t is permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing —Sprinklers _Generator _Roof
Total Sq. Ft'of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2`�(?a. O(� Utilities: —Sewer —Septic Building Height:
Name -e_ tr �( r Cc C Nam
Address: ( 1..;1 V-7 S vi d i cf r1Com a
City: State:_( Addr s
Zip Code: 3 `� $ Z Fax: City:
Phone No. 7 2 Z - �- - Z 7 6 Zip
E-Mail: �a p 7
Fill in fee simple Title Holder on next page(if different E-Ma
_ from the Owner listed above) State
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
u �
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 JOB SITE BEFORE THE FIRST INSPECTION..IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WI OUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.-
ISWe wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 114 bu o,,c COUNTY OF
The fs{going ins t was acknowledge before me The forgoing instrument was acknowledged before me
thLs day ofumen20L.by this day of 20_ by
gEl C2
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden�'ication Type of Identification
Produced L Produced
(Signature of Notary Public- ature of Notary Public-State of Florida)
,,a;�YP�B�, KAREN S. NIELS
Commission No. __ �s t pp of Florida-Notary ublic
• � F(�mission # GG 20 4§9R fission No. (Seal)
My Commission Expires
June 2 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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