HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEv
Building Permit Ap
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
PERMIT APPLICATION FOR:
Address:
ber: � U t- UUU I
RECEIVED
catio I FEB 01 2019
ST. Lucie County, Permitting
Residential
Legal Description:
St.
Property Tax ID #: 314 09- 113' oopcQ 5 Lot No.
Site Plan Name:
Project Name:
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_Electric _Plumbing /_Sprinklers _Generator Roof 1Z Pitch
Total Sq. Ft of Construction: b y Sq. Ft. of First Floor:
Cost of Construction: $ 1156o.00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name )C-1 a C
Name:
. i Pi VR,
Address:Q04 CIS(Co�i D(L
Company: icha2,IRLue,kM66g 'lllC.
City:rtd n;erre_ State: !
Zip Code:3Y98,'A- Fax:
Phone No '" -,2yO'5;W
Address:dirt 01 Df SW .
City: Utz kp*cc(s State:!FL
Zip Code:3acl CoQ- Fax:
Phone No?iol�YpQ�-oZy
E-Mail.]
Fill in fee simple Title Holder on 6xt page ( if different
from the Owner listed above)
E-MailX1,6411141Y a 772Adr '/. GoM
State or County License L`C .29029'S'1 9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLE -MENTAL -0 61 U LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: 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.
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 insgagion. If you intend to obtain financing, consult wit er or n attorney before
commencing wo cor-dins v.0ur•-Alotice of Commencement. , /%
Signature of Owner/ Less a/Contractor as Agent for Owner
ignature of Contractor/Lice se Holder
STATE -OF FLO1ID6
STATE OF. FLORIDA-,
COUNTY OF LVGIE
COUNTY OF •'LUCIF_
Thef rgomginstr tl asacknowledge efore me
The forgoing instru t as acknowledg efore me
this7dalyof
this�dayofLem,20�by
�7�20Iqby
'c] IMP _
{Mir)hwl A h /r
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification v
Personally Known OR Produced Identification
Type of Identifi
Type of Identific ' ra
Produced
I I
cr--
Produced',
-
LL 0_f�
(Signature of Not
(Signature of Notary P it-_ c a{ tP of Florida 1
Commission No.
KAREN.S. NIEI,SEN
?�4.'bta'te'0f FIon ta:y Public
- p@ �q
KARE
' os :$�'o' ��S: N11�ii.'.EN
Commission No. �. ° �'=State of Fleleall);t:,,,ar public
- •'—Eommissiorl'�G 207484
MY Commission Expires
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FRONT
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REVIEWS
SUPERVISOR
PLANS
VEGETATION
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TOATIGRtIV
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED .
Rev.8/2/17 .