HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Jr q / SCANNED Permit Number: I -LOS-wo
BY
St. Lucie County RECENED
Building Permit Application Mar os 2019
Planning and Development Services Per
Building and Cade Regulation Division milting Department'!� ' ucie Co
2300 Virginia Avenue, Fort Pierce FL 34982 nty
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED` IMPROVEMENT LOCATION".="
Address:_%DSfI/I� e9lm �I"ipce �O✓ts�ti Aoci�7 `L 3Y'9r7
Legal Description: Afro t4 cres glk 2 LO-T 13 51 q - 2.64.6i
Property Tax ID#: 3a16- �6OI- OO2-O-(OOD-Lf Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: �7✓� Right Side: 791 Left Side: 86
DETAILED DESGRIPTION'OF WORK
%has /she
CONSTRUCTION
INFORMATION:
;,;• A.
.;
Aaartiona wor to e e orme under
E1HVAC Tank
this permit- check
®has Piping
all app y:
In Shutters
❑ Windows/Doors
as
Electric El Plumbing
Sprinklers
Generator
11 Roof Roof pitch
Total Sq. Ft of Construction:
SC Ft. of First Floor:
Cost of Construction: $ r�300to
Utilities: jL]Sewer DSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR.
61'
Name 57 "g f 1JrV17n
Name: L49 Ge%S &K
Address: OS /y%6411e rile
Company: Gus eEkoIt-est
City: oW,Saih-1 1-yaz, State: FL
Zip Code: 7V997 Fax:
Phone No.
Address: 16i0 S gm-avae✓ ilisiN
City: Sla+2vi
Zip Code:YMI Fax:
Phone No. 772-7$
State:_L
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: In(2 d/'�Q
t , Cd✓h
State or ounty License: 0�✓�6S�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION=LIEN-LAW INFORMATION: _
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
City:
Zip:,
Not Applicable I BONDING COMPANY: _Not Applicable
Address:
City:
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/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this _ day of 20_ by
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 Florida )
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17