HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL`E FED FOR APPLICATION TO BE ACCEPTED
Date: �9 ice` �f Permit Number: 19 0 (V J /
SCANNED -- . - RECErvza .
BY MAR 2
St. Lucie County 1ot8
- Permitting oe
Building Permit Application 3k Lucie Co'Unt,nent
Planning and Development Services
Building and Code Regulation Division -
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: oC -Zn'7 ✓U 0`i1it /Ff'/ 4 J ftk[6 r1SQYV 1,XA NJIi1 C5`r7/7i7
Legal Description: C,0AeOgL C/7U1� /S Srz,7,"6-^J I—c6robo
Property Tax ID #: Z --�d�-"Did 7 Lot No.4_
Site Plan Name: / (SIx"at L J Block No. 7_
Project Name:
Setbacks Fr
_Mechanical
_ Electric
Gas Tank
—Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $,�'Q�
Right Side: Left Side:
_ Gas Piping
_Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
_'Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
R/,LESSEE%
CONTRACTOR•:
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Phone IVo. Gltp 2(A n
�Company:,r
t ddress !�
City ,�r9U C, State (y/..
Zip Code: 32 Fax:
Phone No Wr_�
E-Mail:
Fill irifee simple Title Holder on next page( if different-
from the Owner listed above)
E-Mail
State or County License R (o 63
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
PPLEMEN L GONSyTRUCTIQN
LIEN LA !
RMAITIQN
DESIGNER/ENGINEER: _
Name:
Not Applicable
____ .., __
MORTGAGE COMPANY: _ Not Applicable
Nanie -
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 anyapplicable 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 arid accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result imyourpaying 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 recording vour Notice of Commencement.
Signature of Owner/ -Lessee/ ntractor as Agent for Owner
Signa6ife of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTYOF I�CCX9�(Dr
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _4�_ day of 26A by
_
this Ja day of SalnujW 20 Iq by
�eym,,x Mr�tska(I.I
e>..esr arsh&LI
(Name of pers n)cknowledgi�ngg
(Name of person c nowledging)
—
n
��/�Lo-�-�
(Signature Notary Public- fate Florida
r-�
(Signature Nota
of fate of Florida
of of )
Personally Known OR Produced Identification l/
Personally Known V/� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(,,,` g^;C�,,, 'BEV�ERLY D. MARSHALL
"—BMRLY D. MARSHALL
� � •p, •y �(; ••• iLtary P��Iic - late of Florida
I1�
Cornmission.Nc� . , a' 'Notary(�Nlii; State o1 Florida
Commission No. f���
CoCmmi �Ir�i/ 6G 057931
Commission N GG 057931
_
% My Comm. E.pires Jad:8, 2021
j
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'°. Bonder ro,ougn
ationai Notary Assn.
REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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