HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE
Date: 1' )L 19
Permit Number:
Building Permit Appl
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1573 Commercial
PERMIT APPLICATION FOR:
Address:
RECEIVED
JAN 0 2 2019
cie County, Permitt,rg
Residential 41--"�
Legal Description: Gzyo✓ SCANNED
BY /
Property Tax ID #: 149/dp� "Pa St. Lucie GOUITLY Lot No..
Site Plan Name: yGF';r4W .Q%� Block No.
Project Name: 5
Setbacks Front Back:8(> Right Side:LeftSidJR
r—
ONSTRUCTI-UN.f`=INt1OK
A,I;IUN
rtiona wor to a performed un er t
_Mechanical _Gas Tank
is permit—c ec a t
_Gas Piping
at app y:
_Shutters
—Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: 914 Sq. Ft. of First Floor:
Cost of Construction: $ yLrs� ®tJ•00V Utilities: _Sewer _Septic Building Height:
0 NER/LESSEE~
Name GG
Name;2$%lr�£rfe�n�,�rt.-.�� •,t�_
Com an & eZY; � �i/>7,:✓yJ�
Address: 9B&0 .,,14y
City: T, �i'��'rPli� State:
Address: pyJ rLG 6—
City?;g i �r G state: i
Zip Code,. }? A2- Fax:
Phone No.
Zip Code: �� Fax:�ii,7--�O��S'�i
Phone No ✓7%97
E-Mail r—
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License r—� V
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice ot•Commencement is regwrea.
SOPPLEIMENTAL CONSTRUCTION LIEN L; INFORMATION:
f
DESIGNER/ENGINEER:
Name:AA. A 4
_ Not Applicable
MORTGAGE COMPANY: _
Name: ,"
Not Applicable
AddFe—s
we ----Ad
dress:--- —
----- -
City-7o-W & 4 ems
Zip:3a,[ g!!T Phone /J711
State: -"E�
�'�5L
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name: �—
_ Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
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 fallowing 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
commencineAvvork or recording vour Notice of Commencement.
Signature of Contractor/License Holder
Signature of Owner/, Lessee/Contractor as Agent for Owner
STATE OF FLORID4
STATE OF FLORIDA L
COUNTY OF ,i UC'.l F
COUNTY OF
The f oin instru ent was acknowled a before me
this r day of ( � 20]� by
The foj� oin instru ent was acknowled a efore me
this Z day of � 201by
(Name of person ac <nowledging)
(Name of person acknowledging
AA L �', L=:= —
(Signature of Notary Public- State of Florida )
(Signature of Notary Pub c- State of Florida )
/
OR Produced Identification
Personally Known OR Produced Identification V
Personally Known
Type of Identif+eutip'n
Type of [den tificatIII o
Produced 4— L
Produced
;.oM KAREN S. NIEL SEN
Commission No. °�'oState 0 '91)da-Notary Public
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Commission a ° °'': KAI N g
;y K Commission R GG 207464
°c My Commission
;n dot ° Florida -No SEN
=,'o„f��,?�� mmission tary Public
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