HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE6
Date: ytl\ Permit Number:
Building Permit Applicati
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 31 2019
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ke 1
PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Des
Property Tax ID #: 3'1 Iq ^ 54� ' n�1S 3— 0�0- Lot No. �0
Site Plan Name: Block No. —I—
ProjectName: Qm Vieyy cie
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
eMNC-e,X'iS-V\YI v() 0\own At YU ec. 1 nS+oA\
Rew ►M'\\\ �_' 1 Y� C-ACk\va\Uwt 2[v 9"-f) 5V ('01Yk v
Vv�ka\ fU0��fc SON) Im
CONSTRUCTION INFORMATION:
Additional worK to be errormea under tnls permit— cnecK all [t apply:
1JHVAC Gas Tank []Gas Piping Shutters ❑, Windows/Doors
Electric El Plumbing Sprinklers Generator L Roof M Roof pitch
Total Sq. Ft of Construction: d S Ft. of First Floor: d f lJ 1 SC1 Y�
Cost of Construction:$ R;0 1.57() utilities: Sewer Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name \
Ckn
Name:
Address:
'IL
Company:
City:1.
Zip Code:
Phone No.
State:
Fax: KI
— CAOC13
Address: 110-ISE H&ed • A>'
City: • • . LLW f State: L
Zip Code:v1c�� Fax: N &
Phone No.l,a- — 9-3,11-1--1LOto j
E-Mail:IAve\-� )2AgSU) 116 VIIAM I\• (OM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: (CCCC-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
f
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 k or recording our Notice of Commencement.
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Signature 99 Owner/ Lessee/Contractor as Agent for Owner
Signature of C tractor/License Holder
STATE OF FLORIQA
STATE OF FLORI
COUNTY OF Sh N..Jcs�
11
COUNTY OF I IaCI�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
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this day of 20AI by
s r'N
thiday of 2011 by
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5a�r r6JaS
Sohn w tubs
Name of person making statement
Name of pers making statement
Personally Known OR Produced Identification
Personally Known I/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu c-State of Florida
(Signature of Notary IEGIVENS
my co MISSION p GG 022023
Commission NoEXPI ♦ 4t ember16,2020
Commission No. Public S�Sealpodda
BondedTlw Ndwy�I1cGn1eW610R
Nwary
+ Deena M Sabella
+�.. . My commission GG 229100
y off' Expires 06/1412022
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Rev.8/2/17