HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 19 0 Y
Date: 4� "Vlgq 3 Permit Nu brrf ®o^om
AUG 19 2019
Building Permit ApplicatWIPermitting Department
Planning and Development Services St. Lucie County, FL
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: L4 3 Jo v e r P i G Y\ In\ cw
Legal Description: -a, x-Qy-,S Cove -Orn;� 1 $\ Y, t6-F A
PropertyTaxiD#: 1IL( ICl • 701 . Bn R9 -600 - h� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L DETAILED DESCRIPTION OF WORK_:
DOC-K Qefc,i.--l'FemoV*"icY\
'CONSTRUCTION INFORMATION:
I__JHVAC LJGas Tank (JGas
.Electric 0 Plumbing .Spr
Total Sq. Ft of Construction:
Cost of Construction: $ %?6 J o?• 76
Piping L_1Shutters
nklers Generator
_ Ft. of First Floor: _
Utilities Sewer � Septic
E] Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE:-
CONTRACTOR:
Name ASP i�l� � i j cc•n �a
Name: L.
Address: 43 Sn-iPrc-;ate ��o.r
Company: MY. ps/A
Address:?. 6• t?oX
e.
City: For } 2:erc.0 State: tea V
Zip Code: 35i fy `1 Fax: IVIA-
Phone No. 7 3a 207
City:
Zip Code: 31/9 9 3�
Phone No. 77o2 - )o26 -
State: IZL-'/
Fax: 7 7.- �26 7602'/
76a4/
E-Mail: 00c. / - coOVI
Fill in fee% mple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
ref
State or County License: 4�
G'ePI 7 S6-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
EM
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: �'q ,e /i .a
_ Not Applicable
)AdL
MORTGAGE COMPANY:
Name: bill nc,inp ni
_ Not Applicable
.
uA Kc,L'
Address:
City:
Zip:. j 5/ SEs/ Phone'7-2-
r
State:
-2A5- 4SW&�
Address: goo J
4g l-
it l i S/
City: StocKdon
Zip: %S sn Phone:
Stater
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
commencine work or recordine vour Notice of Commencement-
7�b / __
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Signature of Owner/ Lessee/ Znnnt ast ent r Ow er
Signature of ContraMor/License Holder �—
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _111)MaAl
COUNTY OF /lIAR_r7A1
The for oIng instru ent was acknowledged before me
9
The for oing instru nt was acknowledged before me
this day of 20/ by
this day of . 20%9 by
Name of pers making statement
Name of persg making statement
Personally Known OR Produced Identification
Personally Known ✓ OR Pr
Type of Identification
Type of Identification'4F,•,� pEONEMUECK
Produced
Produced!MycWMISsioN#GG2BSZ
EANECK
' t1 COMMISSI0NSGG2&5220
EXPIRES: Dacea ber l8,
��:�?: �'
1 2022
• BaidedtlxuNofatYPut�
(Signature of N
(Sig ature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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