HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: La 1 Permit Number:
RECEIVED
18
Building Permit Application 2021
Planning and Development Services .Hitting Department
Lucie County
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: P � �� G �I Of l vl IilX a&F) L 14 6)
Legal Description:
Property Tax lD#: �I S 7 — I / I J 6D D— u Lot No. 3
Site Plan Name: Block No.
Project Name: e d w f1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1 5'(b 01- 000-�/' /te'r( 0 C-Unto r oo Q)-C^SV_
CONSTRUCTION INFORMATION:
Additional work to e nertormedun er this permit—check a apply:
11HVAC0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers E]Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ /6 2 Do Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Q f`! (ib Ifli'l Name: A 5 0 . �.`JGU lS
Address: (�S a rc, Y r1 Company:1 eA iPc nt r
City: 04rn LWIC'o State:fb Address: (3 40 _? 9 PL CT N
Zip Code: 3y 9 a"? Fax: City: (.,)e9 State: FP
Phone No. 3&9- A3 5 — (2L 25I Zip Code: 3391 a Fax: 5'(. Q -46SL4
E-Mail: Phone No. 1,SU —@ 'S 5
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C.6 C O axz I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INF.ORMATION _,__
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
1/ff QQ0
Signature of Owner/Le see/Contractor as Agent for Owner Signatthe of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO DA
COUNTY OF - C� COUNTY OF�G�II/1'1rA .
The forgoing instrpment was acknowledged before me The forgoing instrument was acknowledged before me
thisQNay of ���/��<v/ ,2021 by this) day of E-4?r, ,20dA� by
MC,Cy Co yI �AK,C_�5 us
Name of person making statement / Name of person making statement
Personally Known OR Produced Identification (/ Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced On ✓ r'5 Produced
(Signature of Notary Public-State of FI rid ELMN ESPI L(Si`gnatiKe of Notary Public- axe of F rd a)
,r� � ANGELAYOUNG
n My COMMISSION# H034602 =�'� '' ` ommission#GG 968161
Commission No. � Q,5 p EXPIRES:AUG 2 ,GMmi �,sion No. �, S�eal�
Expires April
Bonded through 1 st St to Insursno r, FF'�a 202
FOFF�O Bonded Thru Budget NotaotarySe i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17