HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLcr--D FOR APPLICATION TO BE ACCEPTED
Date: d% I �, Permit Number: �90 . e(0 09-.
F EIVED
s`
Build ng&rAWbAppl
Planning and Development Services BY
and Code Regulation Division 81. LOCI@ County
2300 Virginia Avenue, Fort Pierce FL 34982 y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
MAR 2 7 2019
Permitting Department
St. Lucie C nty, FL
Resi entia
PERMIT APPLICATION FOR: ?v t9 L r 1Dtr-
Property Tax ID #:
Site Plan
Project Name:
9
Setbacks Front Back: Right Side: Left Side:
Mechanical
_ Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 240() , QU
—Gas Piping
_ Sprinklers
au tnat apply:
Shutters
Generator
Sq. Ft. of First Floor:_
Lot No.
Block No.
_ Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
G1WIt(ER%LESSEE: �{'@
�. ONT1R�A�(:"iqgy
`Z l:-Zr�.S^� �£•n k a'
a.
Name
-Let
Name: 1
1
n
Address: O
Company:
Robert T
City: R . Ri crCe-- State:
Zip Code: 34q 0 I Fax:
PhoneNo.7
Address:
City: P+ , PiPr('_P.
Zip Code:3LJCN9� Fax:
Phone No 17Q -4(t5-1)2(;4
Stater
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail TY l oni O&to (,. u ii)
State or County License CFIC 061�
0(09
it vame or construction is 2500 or more, a RECORDED Notice of Commencement is required.
of App icable MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE
Address:
City:
Zip: Phone:
— Not Applicable
BONDING COMPANY:
Address:
am
_Not Applicable
I - y-1 ��-• r FVMUr vn nrriuvi a : Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that nttoo� work or installation has commenced prior to the issuance of a permit.
which is In cof171cttawith any applicable Home Owners tAsssociation ru es authorize
by aws or anScovenants that build
restrictbor 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
commencine work or rprorrlina vnnr hintiro of r'........................a
Signature of Owner/ Lessee/Contractor as Ag nt r Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S-r . I p g� Q
COUNTY OF !�;t
�_l
The forgoing instrument was cknowledged before me
this � day of _ M r _ 2p� by
The f rgoing instru t w acknowledg efore me
this j day of
z011by
(Name of person acknowledging)
(Name of person acknowledging)
onU 1 IA
MrAAAQQ4AkZAn�
(Signature of Nbkary Public- Stat ' f Flo )
(Signature of N&tary Public-Sta of Flori )
Personally Known y�y
Personally Known e ti
c ti on
',rn•> "'-. KARtEY MAAIEGIESY-VARNEY
Type of Identificatio "' ""
Notary
Type
IdentificationPfodUced
ry Public -State of Florida
.KARLEY
c
Produced 8;
MAREGIESV-VAANCommission
f GG 0998o1
,a yComm. Expires May 1,2021
MCommission
AL
Notary Public-5tateof Flori a
Commission aGG 0998o1
No. SMg ugh Nadonl NowyAsm.
Commission No. a Comm. Expires May 1, 20 1
dedflh,w9h Nadmel NotaryA, n
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