HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPermit Number: V \a i—o `1
Building Permit Application 'A' p g 2019
Planning and Development Services
Building. and Code Regulation. Division ST. Lucie County, PZ rr
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 17
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
[PROPOSED IMPROVEMENT LOCATION: -
Address: G
Legal Description:
PropertyTax IDN:_Lot No. I,alll AID
Site Plan Name: Block No. owl
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:
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F,rtb rvLw lrbt �' g}r,� Z_4 nQ,.� .� a v. cE, ,re w r_ T+^ tP t i
CONSTRUCTION INFORMATION:
LJHVAC L�-1yGas Tank UGas Piping "Shutters
LJElectric L1Plumbing Sprinklers 1:1Generator
Total Sq. Ft of Construction: 5. -7OA S Ft. of First Floor: _
Cost of Construction: $ �I O Jo UtilitiesSewer Septic
[—,,fwindows/Doors
L'J hoof = Roof pitch
Building Height:
OWNER/LESSEE: ._ ti
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CONTRACTOR: ;
Name wn f JJA6
Name:
Address: %3 Pressu,
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Company:
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City: )-1- re.rc.e...
Zip Code: sqh%-J- Fax:
Phone No. en?-- r5L16-
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Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail: t-[i,Jmy iAc. o c gvtu i A Art
Fill in fee simple 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.
SU-P,PLEMENTAI CONSTRUCTION'LIEN LAW INFORMATION': - -
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 recording vour Notice of Commenrement_
Signat n e/Contractor as Agent for Owner
Signature of Contractor/License Holder
OF FLORIDA
COUNTY OF 6-� •
STATE OF FLORIDA
COUNTY OF
The forgoing instr�fnent was acknowled before me
The forgoing instrument was acknowledged before me
this � day of .)'A.)'AY\ . 20�by
this _ day of . 20_ by
S`.'1g"Yr. '-J �' 1'�10
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifcation
Produced ti� `
Type of Identification
Produced
(Signature of Notary ublic- State NpNtEOGG py,023
(Signature of Notary Public- State of Florida )
Commission No. tJM U �R
Commission No. (Seal)
REVIEWS
FRON
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17