HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP'& ED FOR APPLICATION TO BE ACCEPTED
Date: 1—, 331 - Lol7 — _— -_ ---- -- - -Permit Num —�^-rkECEID
- - — Building Permit Appli ation BAN 2 3 2019
Planning and Development Services Permitting Depart)
Building and Code Regulation Division St Lucie Count
11
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: �eOV 0 1/OG } i 0 ✓) . SCANNED
1.,
Address:
Legal Description:
TOO) L
Property Tax ID #: / Lf 2s 701 0/4 �4-3 Yq Lot No.
Site Plan Name: LeeM )or Block No.
Project Name: !y l2
Setbacks Front Back: Right Side: Left Side:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction: Cost of Construction: $ .2 s—e
bl
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
GONTRAGT: LQB:
Na a
LL�IG' 'C Itl C SIC, i 1
Ad�ess: /./. 9
Companyuz , i
GrletAlM
ci rG f' 0 :" :`' E - N State:
Z! ode; S��iQ v Fax
Phone No. '--
Address: y O." If _- f d ✓U
Stater
Zip Code: �ZZ�.�� Fax:
Phone No 9 4 — 608 -- 3V91
E-Mail: �—
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?PLEMENTAL GONSTRUCTION
LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
_
MORTGAGE COMPANY:
Name.
_ Not Applicable
Address:
Address:
City:
Zip: " Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not 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 l 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 imyour 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 lerider or an attorney before
commencing-mork or recording vour Notice of Commencement. ,
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OFFLO /l
STATE OF FLORI�A-,,, -_ ((��
COLINTY OF c� cf
,,
-COLINTY OF ,(: Z oc��X `
The for oing instrument was acknowledged before
The forgoing instrument was acknowledged before me
this Rday of (Jl 20a by
this_2,i-_dayof20A by
�ealec\� M r- 11
Morr.Sl-I,
(Name of ppe1r1so1'^ck/Inowwlleddlgiinng)
(Name of persona knoow(lle�dgiing)
/7
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Knowny OR Produced Identification
Type of Identification
Type of Identification
Produced `
Produced
I S x,rRLY DMARSNALL
Commission No. CiG09 J 1Notai(15Aa{)ic !'State of Florida
P" _DLVLMLI D. MARSHALL
id �yap ary PuGli4Qc� Rig of Florida
Commission No. "CommissioSY�r G 057931
Commission a GG 057931
'M
-
My Comm., Bzpires'Jan 8, 20211,
'•.,d�<o
- =� e`•` Comm. Ex ires Jan B 2021
..�R.
•"�°����•`d
BondedtAraug
ya!ionai Notary Assn.
REVIEWS
FR
PLANS
VEGETATION
SEATURTLE _
MANGROVE
COUNTER
REVIEW .
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2U14