HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COlvirLaED FOR APPLICATION TO BE ACCEPTE_
Date: Permit Number: n rl LQ `
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID In W) —
Site Plan Name: hI-VC11e 1 �I\�
Project Name: l- r-,,,Pd P A) P k 1
at;ANNE® RECEIVED
BY
3t. Lucie County MAY 31 2019
Building Permit Applicatic n
ST. Lucie County, Permitting
Commercial Residential r
Setbacks Front Back: Right Side: Left Side:
maonai worK
_Mechanical
_ Electric
_ Gas Tank
-z/Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ gi O O
_ Gas Piping
_Sprinklers
Shutters
Lot No.
Block No.
-Windows/Doors
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
,W /LESSEE:
CONTiRA' OR:
Name
Name:
Addre
Company::
City: Sta a
Zip Code: Fax: _
Phone No. � �) ��0 i7S 3
Address:
City Sta
Zip Co e: Fax:
Phone -,I-,Ii 4 GAT oar
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Q 0)
a �
State or County License Q F r n O r!n
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
Name:
City:
Zip:,
7FTOM
FEE SIMPLE TITLE HOLDER:
Name:
Zip
Not
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
City:_
Zip:
_Not Applicable
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 wner/ Less
Cont s Agent wrier
Signature of Contractor/License Holde
STATE OF FLORID1
COUNTY OF
UPA I
STATE OF FLORIDA
�
COUNTY OF �� 0
The forgoing instru nt was acknowledgg before me
� �
The forgoing instrument was acknowledge before me
�
this day of
201 by
this_ day of 20 by
(Name of person acknowledging)
(Name of person acknowledging)
<rjAQPW AA_4
QA
kjl`lAhy1��(11Q Uk QQ[
(Signature offficitary Publib-ttateV Florida )
(Signature Notary Publi f Late lorida) lJ
'fi 'o
✓
Personally Known
O P o u I n
Personally Known . OR Produced Identification
Type of IdentlflCatlon
.......4 KARLEY MARIE GIESY-VARNEY
Type of Identification
Produced
Notary Public -State of Florida
Produced °va,,••, KARLEY MARIE GIESY-VARNEY
;•. •: Commisslon tl GG 099801
. s•, otary Public - State of Florida
Commission No.
• „� MyycFa'Q�OmSQqj Expires Ma 1, I021
ec4tlPtt�ldgh National Notary As".
Commission No. I' :'s CCz,gqffnniarrfl�lWIon AGG sMay 801
1.2
My1C-0(Aaltxpire5MaY 1, 2021
•.,, �?nrv+ Banded through Nalinnal Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 112014
V
All APPLICABLE INFO MUST BE COMPi:r i'C=D FOR APPLICATION TO BE ACCEPTED '
Date: 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
Building Permit Application
Commercial Residential
PERMIT APPLICATIONFOR:
' 0'.® ®. '°0 ® ®Liam 1M
r
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
_Mechanical _ Gas Tank
Gas Piping
_Shutters
—Windows/Doors
_ Electric _ Plumbing
_Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:;
Sq.
Ft. of First Floor: '
Cost of Construction: $
Utilities:
-Sewer Septic -
, Building Height:
4WNE12/LESSEE u
0611TRA °�R;
Name
Name: t
Address:,
Company:
�Cit = __ State:
Zip Code: Fax:
Phone No.
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.