HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE Com�'�ETED FOR APPLICATION TO BE ACCEPT"
Date: �,I y // f Permit Number:
"—' — Building Permit Application FEB 19 2019
Planning and Development Services LST.Wde County, Pemlltiing
Building and Code Regulation Division
2300Virginia Avenue, -Fort Pierce FC34982- - - - - - - --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
'Legal Description:
3
Property Tax ID #: IQ Lot No./3
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 _ Roof Pitch
i
Total Sq. Ft of Construction: _ rSq. Ft. of First Floor:
Cost of Construction: $ 1 Z Oy • Utilities: —Sewer _Septic Building Height: r .
r ,
OWN ER/LE-SSEE:
CONTRACTOR:
Name '..%y1 /tii a Vtl: aad m .:
Name:. 4Z ' ,
` ' V-r•
Address: tfol NG Orliarrl 'A
Company:"ipr0;4e✓
city: p5� rt Stater'&,
Zip Code: 3Yf f Z Fax:
PhoneNo. 9 3 Y
Address:
City: 9 1.4D4/4-
Zip Code: 3Yyy7
Phone No 1-71- 17Y5-
State: r�
Fax:
37 b i-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail PMvltA s -3 6!
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State or County License
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RO 7 S�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S I LIE MENTA CONSTRUCTION LI ,N LAW INFORM
-' gm:
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 trice 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
commencine work or recording vour Notice of Commencement. _
-A)
g ure caner/ e/ ontractor as Agent for Owner
ign ure C ra or Licens older
STATE OF FLORIDA
STATE OF FLOR
COUNTY OF I -
COUNTY OF
The fo oing instru as acknowledgg� before me
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The f oing instru s acknowledg before me
this N day of 20(`L by
this TT day of 2(� by
\ 'Rov ehz Pw()
S .. 1,
- q_'o Venn%'nd
. f,MtA, I_
,— 1P IA
Name of Verson making statement.
Name o erson making statement.
/
Personally Known OR Produced Identification r
Personally Known OR Produced Identification
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Type of Identn
Type of Identific
Produced UL
Produced
��Iva 0'.4 1 L J
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(Signs re of Nota
(Signature o Nota
Public- Sta4 o F
oo.:^.°"' KAREN S. NIELSEN
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KAREN S. NIELSEN
pP°BL-.
Commission No.
o'o to of Fid6ealPytary Public.
Commission No. Flo(§ Mary Public
' =Commission # GG 207484
Commission Expires
zy ommission 4 GG 207484
-'%',+,wr,ro',c' M1i1Y Commission Expires
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REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MA E
COUNTER
REVIEW
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DATE
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DATE
COMPLETED
Rev. 8/2/17