HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOBE
Date:
Building Permit -A
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
JAN 14 2019
Permitting Department
St. Lucie County, FL
Pcirlantial X
PERMIT APPLICATION FOR: Foundation .0. 111
JMPROVEM
Address:
Legal Description:
Property Tax ID #: G:1 Z> —U_ok - M M - C no -d Lot No. 1�
Site Plan Name:)U�,«-N MDrris Block No.
Project Name: C-LtS= Mla(d.s
Setbacks Front ' Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: ,III
CONSTRUCTION_ INFORMATION: 1111
❑HVAC U Gas Tank ❑Gas Piping UShutters
❑ Electric -- - ❑ Plumbing . ❑Sprinklers _ " ❑` Generator
Total Sq. Ft of construction: S Ft. of First Floor:
Cost of Construction: $ . 7 Ol7 Utilities - Sewer ❑Septic
QWindows/Doors
❑ Roof ❑ Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name RUd �US1Vt or .'S
Name:- G�jy�%�
Address: �7 TW 6v% Cree*-S: _Dr•
Company: %CkkN�i l
City: Ft;7
'•; I i.er-CP State: FL
Z.ipC6dei,34945ir Fax:
Phone No. (772) 489-3041
Address: 11_4UO3 0tY-1 w\ S+
City: kr_wspnV�S�\P State:
Zip -Code: 5ZZ(B Fax:
Phone No.gcg- c3(O51
E-Mail: shovel4life@bellsouth.net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: C, &C 1S1891NO
If value of construction is $2500 or more, a RECORDED Nonce at Commencement is regwrea.
m
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN E /ENGINEER: _ Not Applicable MORTGAGE -COMPANY: _ Not Applicable
Name: fl r,001 - CO01 -V--Name:
Address:2.0 \W/J in k Address:
City: c_ State: L_ City: State:
Zip:332525 Phone (03- Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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
,,.. .. nr4 nr rornr�inn vnnr Nntirp of r'nmmprlrpmpnt-
(/1/VI
Sign ur of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF stwaa
COUNTY OF gi-.1 Luce.
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this day o{f-1tV8QC UVf 20JS by
this +st day of o�esr 20_ by
6—� ✓
�
Susan Moms
" ` `
Name of person making statement
Name of perso eking statement
Personally Known OR Produced Identification x
Personally Known OR Produced Identification
Type of Identification
-Type of Identification
Produced Driver License
Produced
(Signature of tary Publi
of Notary P tecfP16fiNotary
public State of Florioa
No. GG246216 ? C�SIi3d �, Kuster
Imiature
� A.SI�+FEBUR9142Commission
mission No. n1Y co
m _ My Commission GG 2a6216
poi Expves
Au 31,2019
w
no'� 08/07/2022
REVIEWS
FRONT
ZONING
SUPERVfSOR
PLAN
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIE
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev.8/2/17 . .I /