HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COVvrr�ETED FOR APPLICATION TO BE ACCEPTL- i ^
Date: Permit Number:C)q �%f\
SCANNED RECEIVED
- 3 BY
s : St. Lucie County SEP 2 4 2019
Building Permit Applicatio
ST. Lucie County, Permitting
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: `�� �� OtAt"Y—
Address:
Legal Description:
Property Tax ID#:R`: --1M4-3,9 00 Lot No. 1�6
Site Plan Name: I )a) i I A V�ct Q,_Q A Block No.
Project Name: ilV 1� �1 Ck "QJ
m�Il1�
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ a14 CSC"�)
—Gas Piping
—Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
-Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
QWNER%✓✓ITI SSEE:
GONTiRA ®R:
Name
Name:
Address:
JOA
Company: I C
City: J S� _U t ,{ Stag •
Zip Code q'�R a Fax:
Phone No.77A `A,I Lo :�QS
Address:
City Statue
Zip Co e94q�Ra Fax:
Phone No ") -) a- q G Diil
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
C, OYl I �I. (►,tS K)
State or County License C (= � d� 6 �
If value of construction is 2500 or more, a RECORDED Notice of
is regwrea.
SUPPLEM -NTAL CONSTRUCT ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:!
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
-FEE -SIMPLE -TITLE-HOLDER: -=Not Applicable ---BONDING
Name:
COMPANY: _ —NotApplicable
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 use's 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_oP*eGw_ding your Notice of Commencement
Signature of Owner/ Lessee/Contractor as A t for Owner
!
Signature of Contractor/License Holder
STATE OF FLORIQQA '
STATE OF FLORIDA
COUNTY OF S-F` L�Ae i Y
COUNTY OF S� L lx a 4
The forgoing instrument wa acknowledged before me
this' day of �� 20 1� by
The forgoing instrument was acknowledged before me
this'dC�. day of 201_q by
J
(Name of person acknowledging)
(Name of person acknowledging)
Kat �QA ffl0'UQA!aVo.�c-
1 R o�► V
(Signature ddNotary Pub -State f Florida _ -
(Signatur f Notary PubW-State\o0FIoridaLK
Personally Known
Personally Known —
Type of Identification o""""�l KAALEV MAAIEGIESY VAANEY
"" "
Type of Identification .+.J"" MARIE
Produced Notary Public-StateofFlorida
�3{• �Notary Nhlic-State o(Florida
Produced•M�bgoims
May 1, 2021
Commission No. WW
YMycommbolresMay1,2021
Commission No. 9 B G hhallaNl Nateryksn,
F6rjkyarja v
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
Q
RECEIVED
/
DATE
COMPLETED
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