HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETtu FOR APPLICATION TO BE ACCEPTED
--Date: a1T_ _ _ _ Permit Number:
FEB 0.4 2019
Building Permit Applica ian-yrigcgun�_y, Pero
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:
PROPOSED INPROUEMENT LOCATION: -
Address: �360\ ` raj eyWR VU F4 `i ",Peg-e _ ,1- I 3 f9sl St. Lucie County
Legal Description:
Property Tax ID#:1301 - (�Ocf- (DOI - OQb^ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator ✓ifoof S Pitch
dr �
Total Sq. Ft of Construction: SA4 Sq. Ft. of First Floor: i
Cost of Construction: $ 1 ; 0OV, oo Utilities: —Sewer Septic Building Height:
OWNER/ILESSE
EGMNITIWAT&TbR:
Name Lori Irr\
Name:
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,, pp
Address: Sq\Qfw--.) lccX
Company:
&\6[Ct1A.P- Qt%)91ro
City: f-F PeerC-c- State: F(
Zip Code: Fax:
Phone No.
Address: �Cii
3 So 6\c6l p- S -F
City: GA
Zip Code:
Phone No
Sk IDCI-r-
3 E99-1
--I-IQ Ukr4- gS6S
State: F(
Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different.%
from the Owner listed above)
E-Mail nz x4e&^.�C-
CAwi
State or County License CCC
13,3 1t-1 O
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONS ION LIEN LAW INFORMATIO
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
comme in work or recordin our Notice of Commencement.
"aQS�11
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Signature of Owner/ Lessee/Con ac or as Agent for Owner
Signature of Contractor/ 'cen older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S a . LO cte
COUNTY OF 6• L O--, R
forg
Theoing instrument was acknowledged before me
b
The forgoing instrum nt was acknowledged before me
`_
this day of �P 2a \ by
this day of , 26A by
1_0\c,n& W%Vk4
KONgk L'1"%N2\j
.,'
Name of person making stat ment.
Name of person making stat ment.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica ion
Type of Identification
Produced l k_
IZ
Produced L 0 L
(Signature of Notary blic- State of Florid
(Signature of Notar Pu
'
�MgRIE GNENS
Commission No. Q S" f `•y ASSIGN A GG B22U2�
Commission No.
..... , DEAN U1idARIE GG 022
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REVIEWS
FRONT
ONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev, 6/1/17