HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO
//MUST BE COMPII= =D FOR APPLICATION TO BE ACCEPTED , '
-Date:-- --Permit Number:
RECEIVE®
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building. Permit Appi
Commercial
PERMIT APPLICATION FOR: 4 )�67J�)
Address: —Ss I "A (�> i ( CA�\
Legal Description: SKIM IA/)
S
JAN 15 2019
Permitting Department
St. Lucie-Cqunty, FL
Property Tax ID #: 3 K (3 I Lot No. r �{
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: �a i Right Side:, _ Left Side: -,
MUUI UUIIaI WUI& LU UC PUI I U I IIICU UIIUCI LIII] PCI IIU L—u1CLN all Lila aliply. _ I
Mechanical —Gas Tank _Gas Piping —Shutters —Windows/Doors
t� Electric _ Plumbing —Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: I (0 0 i Sq. Ft. of First Floor:
Cost of Construction: $ h 20-1 0 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name & &A-�r� nlZ gA-0
(+Z
Name:
Address:4 SC14 6;(CJ'z
Or •
Company:
City: Et, rk P; t -CiP
Zip Code: It Fax:
Phone No. I) a - S`>-
State: EC-
9 - ab 0? /
Address:
City: State:_
Zip Code: Fax:
Phone No
-It
E-Mail: 'ar S w?, t{ 1S q rr% at • C<>-A
Fill in fee simple Title Holder on next page ( ifT
from the Owner listed above)
E-Mail
Sta or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPL -MENTrA GONS . ION LIE .111,
DESIGNER/ENGINEER: —Not Applicable
Name: 0 rv\rt4.e tJ T- �oAd w�tl
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: •
Address:
City: 10 States
Zip:C—P 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.
no
:e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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 your Notice of Comm ^cement.
' a uce:o Owne /Lessee/Contractor as Agignature
of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
JOrler
COUNTY OF
COUNTYOF
The forgoing instr nt was acknowledged
he forgoing instrument was acknowledged before me
this day of 20
his day of 20by
C— S1Name
of person making statement.ame
of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
"
Type of I ification
Type of Identification
Produced A L
Produced
(Signature of N6Jary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 812117
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