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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CC'".A_ETED FOR APPLICATION TO BE ACCEPT4& Date: ( _ Permit Number: -© U), �- i'g Pe 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 PERMIT APPLICATION FOR: Vddr`e`sT2 Legal Description: � -IREC-EIVED- `AltoIcatio JAN 0 8 2019 ST. Lucie County, Permi Residential SC;ANNED B eRTaAl N41V 221'602 6- 130 — 00 0 Lot No. Site Plan Name: Block No. Project Name: /2j-N0 (1,4r[01t1 Setbacks Front Back: Right Side: Left Side: _Mechanical _Gas Tank _Gas Piping _Shutters =Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction Cost of Construction: $ 2 aP Sq. Ft. of First Floor: Utilities: _Sewer _Septic . Building Height: OWNER/LE-SSIrE: CONTRACTOR: �i90 rarrvmo¢ Name: Vmenf3,YP_ Address _17I oa "li-n (Qc. rLr4 Company: City: k- 9 1 Er C.-'-- State: Vip Code: 5y Fax: hone No._��Z giz/ 8l 38 Address: - City: State:_ Zip Code: Fax: Phone No Mail: aAQ3 -aw'a %P5 tw YAH(Dooe-nYYl i , ill'�n fee side Title Holder on next page ( if different from the Owner listed above) E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEM =NTAL CONSTR • LIEN LAW IN ORMA ION: DESIGNER/ENGINEER: Name: _ Not Applicable r'1 MORTGAGE COMPANY: _ Not Applicable Name: �\ Address: , .: �_ f _j Address: 1 City: Zip: Phone State:,? •-J. , T . aq: / I State: Zio'. b L /: Phone: FEE SIMPLE TITLEHOLDER: Name: _ Not Applicable 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`prbhlbit 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. �Jfyou inten obtain financing, consult with lender or an attorney before commencing work or rec&Ainf; your ice of Commencement. % ignafu[e?o[Owriey: Lesseefcontractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA tt COUNTY OF � 4 CI �� t COUNTY OF The forgoing instr ment was acknowledge efore me this day of � 20Tby Pfl l&rgoinggnstfwnent:was:acknowledged-beforehne s this _ day of 20_ by . c�SF.-���o►a 2rzAll�� Name of person making statement. Name of person making statement. Personally Known OR Produced Identification r/ Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced AA c_� (Signature of Notary P Ict, fete of R(A1 9IN S. NIELSEN P`�i:: (Signature of Notary Public -State of Florida ) � State of Florida -Notary Public Commission No. Com �p n a GG 207484 :• _ ryN 1p Expires Commission No. (Seal) r �•, Y M E0 ission June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTL'E_ MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED nev. aiyii