HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _�� `� Permit Number: 19 d� )
-_ RECEIVED
Building Permit Application
Planning and Development services MAR 06 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie Coun , Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linek4, uz ' I`r,: ✓L III
Address: I I XfS
Legal Description: 9 4 ( J
Property Tax ID#: Qo-00(o - coo -lo Lot No.
Site Plan Name: 11 Block No.
Project Name: Oc7/-4-nv-,
Setbacks Front J40I , Back: 34Lo, Right Side: )� Left Side: PRi
�Lr,si-wll 0 �' cX�eci,r LP Soo &,j -G1��C �t�e5 SCANNED
�/T}anor l_P 0 ��nes rt BB4r/�ia+�gp�2�ry4f BY
St. Lucie County
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AaClrtiona wor to a orme under tispermit--check all tti at apply:
OHVAC _Gas Tank as Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing 17ISprinklers 11 Generator D Roof = Roof pitch
Total Sq. Ft of Construction:�
Cost of Construction: $ UDCIs�v.rrr�� . 0b
Spr—F�t. of First Floor: _
Utilities: Sewer 11Septic
Building Height:
;OWNER/LESSEE
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FCONTRACGOR `'
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Name
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Name:
Address:[ A SS cr.,P { tvar
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Company:
City:_JCnf,en �gFag-k State:40,
Zip Code: Fax:
Phone No.
Address: 2030
City: State_
Zip Code:Q Fax:2&0 - IYSQA
Phone No. b7.:6 =-G- Qy?S
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: CMC, i r14-01511 (c)pl�a�s COCnLAA
State or County License: �53iD
1-- -CUP umeu ucrmn n .7cauv or more, a ner.vnveu rvoace or commencement is required.
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip:
Phone:
FEE SIMPLE TITLEHOLDER: _
Not Applicable
BONDING COMPANY: _Not
Applicable
Name:
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
commencing work or recordine vour Notice of Commencement.
Signature Owner/ Lessee/Contractor as Agent for Owner
Shure o ontraMor/L¢ense Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTYOF r�rn
COUNTYOF Mava-iyt
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Ctdayof Mckyy eAl 20L by
this L_dayof 20 t4 by
h ..MtOVt
0e!je-,y1Y,E Ellison
me of pers n making statement
me of persgn making statement
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signs ure of Notary P licvitets Ofrfifpy�rJlK State of Florida
Sign r of Nota�ic- State of Florida I
Desiree N McIntosh
Commission No. My Co sis�on GG 283399
r,cwre t 2022
Commission No. NotaryRF� 88l1aato or FWda
/nosh
ae
DesiredlVF
My Commisston GG 283399
�04 Expirest2Ht2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17