HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLI BLE I FOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ia 1 19 Permit Number:
RfCftfD
Building Permit Application DtC121018
Planning and Development Services permitti
Building and Code Regulation Division St. Lvc epC.art nt
2300 Virginia Avenue, Fort Pierce FL 34982 anti
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED' IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: MQ I 19UQ 0-L 0002
Site Plan Name
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
DETAILED DESCRIPTION ,OF WORK:
SO I CLi- Pool Sy S+Cry) SCANNED
BY
St. Lucie County
CONSTRUCTION INFORMATION:
AaditionalworKtOoevertormed unclert ispermit-check all apply:
1JHVAc E]Gas Tank ❑ ❑Gas Piping _ Shutters Windows/Doors
11 Electric 51Plumbing Sprinklers Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2-H 0 O .00
S Ft. of First Floor:
Utilities: Sewer ElSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name W I I I ILIim Albyr)!41/it
Name: r 0 P1
f'
Address:5ypl S, It'16I h RIVer
Company: T_V/_1 101l ICILImhIr1gl
In
City: r-j- R eye e 1 State: - �
Zip Code: 34q g Z Fax:
Phone No. `7 7,4- 2-1 U - ZUS 3
Address: G LJ wQ C4 I1-e V V"
I
City: pf- Pie V-et, Stater.
Zip Code: 34c1 5Z/ Z Fax:
Phone No. -71 7.)- H CQ 5- ()2 g y-
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: TIY b n I o rzA 6 l.', P'D rY)
State or County License: rIFT, 0
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION:
DESIGNER/ENGINEER: . _ Not Applicable
Name: �Oseph 6Sino,16l
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 rec-eFding vour Notice of Commencement. �1
Signature of Owner/ Lessee/Contractor Agent for Owner
Signature of Contractor/License HoTffer
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged efore me
this � day of bP-CeMb7PX . 20L by
this � day of bP.� e�PX. 20 by
Name of person making statement
Name of Person making statement
Personally Known __4_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
1\01 QQ d / ia-V7�Ql✓l
f.A}at�V
(Signature o ary Public- State of Flo ' a
(Signature of N§tVry Pub' - '
""'•
••'•° RIEY MARIE GIESYNARNEY
Jrd$L�f{ MARIE GIESY•VARNEY
Commission No. :'�"""• �;'. N i"'P
o; oary uNic-State of
N0 le -State of Florida
Commission No. _. • 1 f
. •; slonYGG 099901
`• • •` CommisslonAGG 099801
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�11°aa� MyComm.Expires Mayl,2021
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My Comm. Expires May 1, 2021
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ZONING
SUPERVISOR
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DATE
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COMPLETED
Rev.8/2/17