HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET'_,. OR APPLICATION TO BE ACCEPTED
Date: -. M, 1 \ � Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
SCANNED
BY
St. Lucie County RECEIVED
Building Permit Applicati n APR PR
9 2019
ST. Lucie
Commercial Residential
PERMIT APPLICATION FOR: Q oo� hrtq�-e t'
Address:
Legal De!
Property Tax lD
Site Plan Name: C
Project Name: %
Setbacks Front Back:
Right Side: Left Side:
Hamnonai worrc zo oe perrormea unaer tms perms — cnecrc du uraL apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Building Height:
UStNER/LESEE:
CONTR'ATC+TOR:
Name Y
Name: V n
Address:
: I Company
!
City: ���..""u P i e. Sta
Zip Code:3 � (Ll Fax:
Phone No.,1_7 7 9 i t n MG-2
Address:
Ci • Statet
Zip Co e: ,A449 R a, Fax:
Phone No
E-Mail: I� I r) Do 1, e�li
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License FCO
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
801PLEMENTAL CONSTRUic-n6wirEA
LAW INFORMATION:
?*'
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
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 r our Notice of Commencement.
Signature of Owner/ ntractor as gent i Owner
6
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLOgL A
COUNTY OF S{.. l UCl P1
COUNTY OF ��. k uG
The forgoing instrument was acknowledged efore me
this Z day � } Q YL'1�2Q Y, 20by
The fo Ing instrument was acknowledged_before me
of �
this day of 5QV 20A by
(Name of person acknowledging)
(Name of person acknowledging)
VDnAn f'YlR.LL,,2I 0 VI VG/I191/,7
1<'('U Q A/.1QJrn ('A C10A14 Y ,V)�-f"
(Signature of No ry Public- of Flor a)
(Slgnature of No ry Public- StateV Flori )
Personally Known OR Produced Identification
Persona tification
Type Of IdentlfiC
Type Of I eR ion KAPLEY MARIE GIESY-VARNEV
,,01;2'.�"S1;•. KARLEYMARIEGIESY•VARNEY
Produced .. .��agpuy;c�StateofFlorida
ei� �:. Notary Public - State of Florida
Produce = s ry ,
MMay g1S.
6•' ' •; Commission a GG0gga01
Commission No. , My Comm. Expirestt gai z1
,u,� My Comm.. Expires 2021
Commis n'f6gg^ aondedthrough NadoraI Notary AM al)
•.........•• through Natlom�laal NotaryAsm.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
All APPLICABLE INFO MUST BE C ., IPLETED FOR APPLICATION TO BE ACC&G v.�J
Date: Permit Number:
:.`i''�•.'".=°•""-..??i`�i` ','fir =-^fib;,-7,�•,.,..m.a.:..,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
„I?ROPOSED INP'ROVEMENT LOGATIO,IN x`t ' ;, s
Address:
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
WpETAILED DESCRIPTION OF WORK
_Mechanical _Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
PeHnuL—LIMUN du umL dIJPry:
_ Gas Piping _Shutters _ Windows/Doors
_Sprinklers _Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
`OWNE04E5SEE "-
CONTRA
Name
Name: j
i
Companye
Address: - i,
City:
} _ State: _
Address:
City: State:_
Zip Code: Fax:
Phone No.
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.