HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((�� r� r�
Date: (o131120($ Permit Number: �" 03-00Q,
Lta�h� RECEIVED
BuildingPermit Application pp MAR ;1T2019
Planning and Development Services _
Building and Code Regulation Division permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie COOMY
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line SCANNED
PROPOSED IMPROVEMENT LOCATION: BY
-- -
Address:
Legal Description:
Property Tax ID #: 330 4-1003 -0 6b 1-b 00 - 7
Site Plan Name:
Project Name: JQ1me5 & M%e_h R-a 1 �f�01"�
Setbacks Front Back: 10 � Right Side: 0 Left Side: l
DETAILED DESCRIPTION OF WORK:
13tCP,y 1006,3u,Jlon W lank • _
awry e eel -A qao 1IhL- fa lhaa
ow,21driecs
INFORMATION:
0HVAC L Gas Tank WPipping
Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ i7 ZZ to q
Lot. No.
Block No.
Shutters ^Windows/Doors
Generator i3 Roof = Roof pitch
5 Ft. of First Floor: _
Utilities: 0 Sewer 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JaMC5 + mt
to
T S
Name:
5
Address: 1119E O tlai. r(\aU30_U k0&J
Company: lViftkTiO &
City: F+. Pu6t'Q'e— State:F I
Zip Code: 3't QKS Fax:
Phone Noo.•1ia- 3a( - -f foS
Addre 6 .S h Hblu—
City: Alk State:
Zip Code: �4i q'a f7 Fax:
Phone No. - 1
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
(4neC19- dbM
(6r& , Ito m
State or unty License: 6 55611( - b{014,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
a I I I- SLOW
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable`"
MORTGAGE COMPANY:
Applicable
Name:
Name:
—Not
Address: _
Address:
City:
State:
City:
State:
Zip: Phone
_
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name -
Address: Address:
City: City:_
Zip: Phone: Zip:
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 oboin financing, consult y'th lender or an attorney before
commencing work or recording your Notice oy/Commencement. /
Signature of O ner essee ntrac r gent r ner
Signature of tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY 017_ 6 j¢Cf }�I i/2/ n= i ZK
COUNTY OF niiii¢i I A&'er
The forgoing instrume t was acknowledged b fore me
The forgoing instrument was acknowledged before me
this 1 day of 0/1 20�y
this�dayof� e✓P — 20,L by
Name of person making statement
Name of pgEson making statement
Personally Known OR Produced Identification
Personally Known_ OR Produced Identification
Type of Iden 'fication
Type of Identification
Producedii!/P.(.1'i �iLrPdS,o \\H\1111111f1//rr
Produced
`````\`�cAMMssr°p
(Signature of Notary Public -State of $oifW)
signature of Notary Public -State ' FIoT' rl, y
i
_
Commission No. r6G0 /790 S o(s�q " Nipd
_ .
%mmission No.4406/ 9%D
%-•'2 46 ded !hN e�:� ?
-Y d d Nips .4
4e•gi ••!lO Undec'H�s:••P�
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REVIEWS
FRONT
ZONING "fi�f9UfifikN
\
PLANS
VEGETATION
SEATu`4 /y';'',;;
I /F
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW'
VIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17