HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 a Permit Number:
RECEIVED
MAR 21 2019
Permit Applicati _ l}, teele EedMty pMl
it,
BY
St. Lucie County
Commercial Residential
Building
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
\1\0-�- o So 1
PERMIT APPLICATION FOR: �� I
Address:
Legal Description:
R
Property Tax ID #: 1 U 3 — 70 2 ^ 07%S — U() C7 h 5 Lot No. '
Site Plan Name:
Project Name:
Setbacks Front 3S• OQ Back: 44 �,00 Right Side: 66 - M Left Side: —2)0 .y0
-- /9Dc1 % :iU
Block No.
uiuunai worK zo oe perrormeu unuer cnis perm¢—cnecK all cnac apply: _ - ,,
_Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ l S 00.4 0
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t 5 10
a (C
Name:
Address:6q(6 A] AS 54 (Cep-
Company:
city: State:
Zip Code: Fax:
Phone No. S6i'y — GSa
Address:
City: State:_
Zip Code: Fax:
Phone No ',25-0 -yl5 96; C)
11
E-Mail: '�(1(yyew 1 �i ';A kOSGID -CC
l(j
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
V ,. C
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTrALGONST
UGTION LIEN LAW IN
ORMATIQN;
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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
commencing w_ofkZ—rrecording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 'SAr. . L Qc %A�
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this"-\\ day of '(` k 20a by
this _ day of . 20_ by
'F y a,,n C %'S C d \ •C A-R.'Z
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced \ t,
t
Produced
(Signature of Notary Nbli
Signature of Notary Public- State of Florida )
Commission No�rTa7 d
•::; � ,_ DEANNA PMIE GIVENS
' r MISSION # GG 022023
� ommission No. (Seal)
E%PI ES: December 16, 2020
•"`;c�i�g:•'
Bonded Tiw Notary Public Unde`wdte
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
nev. 6/2/17