HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONV
W"AWLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: j % q • Permit Number: �9
ECIVED
-- -- Building Permit Appl cationFEB 112019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300Virginia Avenue, Fort Pierce FL34982 St. Lucie
Phone: (772) 462-1553 Fax: (772) 462-1578. Commercial
PERMIT APPLICATION FOR:
PROPOSED INPROUEMENT LOCATION:
Address:
Property Tax IDil: p0g_S0C
Site Plan Name:
Project Name: L dll e—
e Setbacks Front Back:
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-Woy- "V()U-"1 Lot No._
Block No.
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Right Side: Left Side:
O NER/HUSEE:
CONTR CTOR:
Name MWiJ4'li twx C letktalib cLZ 14215UC
Name:
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Add re �s 4�/I �
City: -kA etkt Stat
Zip Cod.�e: Fax: I'
Phone No. - 14 1 g ^ �6I• 4
Company: �P'Y_ ie
Address:
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City: r'00r p4 clue-C State:�L
Zip Code:314gS" � Fax:
Phone No %7%-93(o -661`ot
E-Mail:
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Iv Yivin ((RNCel�wuzancvaw, �.COvwt
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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State or County License ' i9 ,5d r% I J
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not
City: qv��'ry YJc
Zip: 4 —
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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,
accessorystructures, 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
commenciae-work or recordine vour Notice of Commencement.
of Owner/ Lessed/Contractor as Agent
STATE OF FL
COUNTY OF
The forgoing instrum nt was acknowledged before
this )l day of 20A.by
Name of person making statement. mN K
a
Personally Know OR Produced Identificati
Type of Identification
Produced
Commission No. (Seal)
REVIEWS I FRONT ZONING
COUNTER REVIEW
ECEIVED
STATE OF FL
COUNTY OF
The for oing instru nt was acknowledge befr
this f day of�ipby
Name of person making statement.
Personally Known '_� OR Produced Identifica ion
Type of Identification
Produced
(Signature of NoWy Public- State of Florida
Commission No. (Seal),
`K.
PNS
EGETATI
EATURTANGRO
S REVIEWOR I REV EW I V REVIEW ON I S EV EWLE J,.MREV EWVE