HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPron
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Date: SCANNED
.J BY Permit NSt. Lucie County t
Building Permit Applicat1 2019
Planning and Development Services Department
Building and Code Regulation Division ounty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
=PROP EDICMPKUVrEM i�1TLOCAT�IQN:,, s-
Address:
Legal Des
Property Tax ID #: 33aa' ?DD' OOq$- coO-O Lot No. 93
Site Plan Name:
Block No.
Project Name: der n;8
Setbacks Front Back: Right Side: Left Side:
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onai WorKlo oe
HVAC
errormea unaer uus
Gas Tank ❑Gas
Penns—CnecK an apply:
Piping ❑ Windows/Doors
_Shutters
Electric
0 Plumbing ❑Sprinklers
Generator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ �, �P ��•
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
r01NN RE /L SSEE Si. ri��FGON,.�T�RACfTOR
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Name 17Gnn;s \�oHo\hu
Name: I�' '3beX- - Zeallcr.K
Address:'%11 QreerOorte.r Ci r
Company: 5�:Aor F��q
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City: P* 54 Lome. State:2EL
Zip Code:3c4)9$Lo Fax:
Phone No. 33D' 5&6— gr %7—
Address: U00 Srnc;!\\w�,A
4rge.
City: V-•Ir Pie.'ClL
Zip Code: 34ggZ
Phone No.'"1-12- '-IL,t t-
State: -EL
Fax:-7l2- 1-36--7g37
Zblo 3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: SYn50 IcLfxo rle.ra
C. m
State or County License: 0,\/(^,0
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUP glE 'E :T,,,L COI STR GTIph[ L1 N LAW I
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f0( M TIUN MMPr * k
.SiiiPM1. 11t +x n i .,y 51 Y 1
DESIGNER/ENGINEER: _ Not Applicable
Name: 3e��r� Tcorre.5
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 work or recording your Notice of Commencement.
Signature of Owner/ Lesse tractor as Agent for Owner
Signature of Contractor tense Holder
STATE OF FLORIDA
COUNTY OF �r,
STATE OF FLORIDA
COUNTY OF �i L i�
_ ;e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this2addayof A(2r'l 201Q by
this Z-1day offAnr i J ,20_Jqby
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 //
Produced
(Signature of Notary Public- State of F i a j Made Sarah Music
f NOTARY PUBLIC
Commission No. Fq zl3'7 " S bTATE OF FLORID
(SIggnatuie of Notary FPfublic- State of F j Made Sarah Music
e� NOTARY PUBLIC
Commission No. FF0ff21'7i% ( )'ATE OF FLORID
Camnrli FF912137
Canm# FF912137
s�4cE
ce e�m Expires 8/24/201
teI0 Expires 8/24/2011
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17