HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I apt I \`� Permit Number:
I� w SCANNED LRECEIVED
BY
' St. LUCie Coun 2019Building Perm Applicatio PernllEflfl
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 Residential
PERMIT APPLICATION FOR: C_q� �a� �- — cov�cc�,tc
PROPOSED IMPROVEMENT LOCATION:
Address: 3%�� (2�.�C� �CQ �LCrC�t �i 3�1dILl�
: l Legal Descriptioni�L MncVl,�kz e�Atk � A-V1nL S,66& � i u r a� seLtuY, Z� \v P `35 C
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Frontfn$\ . Ci Back: Right Side: Left Side: (C6 , Y,
Lot No.
riaaiuundi worK w ue penormea unuer uuo Pe1rna—cnecrc du LFWL dppry: ,
Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors
,/ Electric _ Plumbing _ Sprinklers _ Generator �/ Roco/f Pitch
Total Sq. Ft of Construction: t- 1! j
Sq. Ft. of First Floor: a —1 S • b
Cost of Construction: $ LA01000. 00 Utilities: —Sewer _Septic Building Height: Ti
OWNERf LESSEE:
CONTRACTOR:
Name Q
Name ,?
Address:'z,')_` a, 'Mo-A�r,C_1,x 94
Company:fazN,,,
City: V, TCLsct- State: L
Zip Code: 3tlaq-1:5, Fax:
Phone No. "777• z0k —t I OS
City: State:_
Zip Code: Fax:
Phone No
E-Mail:ioL`r cLc-NC\opm
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.
SUPPLEMENTAL CONS 1 ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: n;c 'ram
_
Name:
Address: trir�ckve_
Address:
City: `i1 .act Sr_L State: IE-\.—
City: State:
Zip:' -tgsc7 Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 concurrehcy 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 o recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �a I i, e,, P_
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisdayof_��. 20� by
this_dayof 20_ by
Name of person making statement.
Name of person making statement.
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced—
Produced
{y �
`Y IA a A 0 Sk
(Signature of Notary Public- State 9MSTINE PHARIES
(Signature of Notary Public- State of Florida )
NOTARY PUBLIC
Commission No. FtE OF FLORIDA
Commission No. (Seal)
Cormdl FF924375
E.
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