HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �•�. �G� Permit Number: I9 k8— DIO
SCANNED
• St. Lucie
County � I�.
Building Permit Applicati �'
Planning and Development Services
Building and Code Regulation Division MAR 8 E 2019
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial %rs�g� ,W Department
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEENT LOCATION:
Address: � �-O 1 syL no, S TK L
Legal Description: Sk , U,_)6-( G or cI e V) S CX S -�Ln -1 0 '- I\f l�
Property Tax lD #: _5'k IL Lk - SO I - 015 FS - 0 00 ^ 1
Site Plan Name: i
Project Name:
Setbacks Front 25 Back:
15 Right Side: 7-6
Left Side: 7.5
Lot No.�
. . k.
(DETAILED DESCRIPTION OF WORK: III
5�-al\a{•,\oin o-V
°CONSTRUCTION INFORMATION:
AdClitional worK to e erformed under tispermit-check all apply:
��EyyHVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
LVJElectric 12"Plumbing Sprinklers Elenerator Roof Roof pitch
?oat% -Sct d
Total Sq. Ft of Construction:C )c c,iC S Ft. of First Floor:
Cost of Construction:$ S�. D(70'o I Utilities:iSewer Septic Building Height:
'OWNER/LESSE_ E;
CONTRACTOR:
Name l
Name:
Address:�-Ao Vah0. ` P,L
Company: PO81S by �rcS Lr,c-
City: Port SF.LvC\2• State:3L_
Zip Code: 3 �A`l(S Fax:
Phone No. a S t-i - i41 0 - '5 3 1 `�
Address:���Ig S I-L�r�L Hvt�i
City: li�,a r F S i _ Lv ci L State: FL
Zip Code: 3�1 `� S a. Fax:-} a -33-t
Phone No. __-� _)t-a -33_} - T-t 13
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 0 � 4 i 1 o. 0 P 6 o is'jo
�
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUP4P�LIEMEENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_ M ,
_ Not Applicable
R_o ag er S
MORTGAGE COMPANY:
Name:
X Not Applicable
Address: l6oD\
O
Address:
City: F70r r P � e c'V
Zip: 3L�R % a. Phone
State: FL_
d —ao I — I La 3 �
City:
Zip: Phone:
State:
-FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 recording vour Notice of Commencement.
Signature of Owner/ L ee/ ontractor as Agent for Owner
Signature 6GM—t'-fa ' o Lacer older��
STATE OF FLORIDA
STATE OFF 1111A
COUNTY OF MARTIN
COUNTY OF S+. Lv C t L
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 21 day of FEBRUARY 2019_ by
this Qa day of _ _'F7L b , 20L�_ by
ASHLEYGOODWIN
Name of person making statement
Name of pers making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification .
Type of Identificjtion
Type of Identification
Prrood^u'ceedA_. YQ-t� L
Produced
n 1 I
I1UIUXY�Kyk Wnd-
)
tl#�r (iotArT,fi94BfiC±a3t@`N0bf Florileal)
(Si atu of Notary Publi Stat�E f� neth Ellyn Wood
(Sign
< My Commission GG 201733
F�"b851 b Notary Public, State of Flodda
Commission No. �; �}°'� 00mission No. FF9BB516
'qt,,.• My Comm. Exp. May B, 2020
di Expires 03/29/2022
Com is i °Fi
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Rev. 8/2/17 1 l