HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONter.
I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APKICATIOW TO BE ACCEPTED p,
Date:
j 0 -. > 9 SCANNED Permit Number-* J
BY
• e €t`+° ..5.�-=- St. Lucie CoLone� IRECEIVED
Building Permit Applicati n OCT 2 4 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial l9l CO tY, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: t7A
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
&(a r
e(s(cie 5(D S 1 a o�-
o(Z.
fDI - (COI - OCX) 3 -000- (n
Back:
leQ+VLC_1 P
Right Side
11 Electric 0 Plumbing ❑Spr
Total Sq. Ft of Construction: Cost of Construction: $ cgOI [ `f gi a to c)
Left Side:
ing LJ Shutters
=rs ❑ Generator
Sqf —F—t.� of First Floor: _
Utilities:nSewer L Septic
Lot No.
Block No.
❑ Wind
❑ Roof
Building Height:
Roof pitch
1WNRIitESSEE}' fi $y�a'3
G®NiRACTOR° '
Name e-ck4 3
Name: �go6e,rA- ZCC,_kt-LcK
Address: Qb S3-t1 Icw(l
6�n
tJi✓
Company: �5oIGc- Ecae4r�
City:
Zip Code: Fax:
' ^
Phone No. 3(oO q y 5 ry
State F (
CTi
Address: Ifr7 s, �ollr
moo-,
FNe
City: FE C.e�G2
Zip Code: 34cJ8y
Phone No. 7-72' q(4f-
State:�L
Fax: -7-12-'f p-i q3-7
2-to (03
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
GV7CC�S(r1o31
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSI'R`UCTION LIEN LA INf
� RMATIONc -
DESIGNER ENGIN,€ER:� Not Applicable
Name: TliN S� On Qt,
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 our Notice of Commencement.
K
x
Signature of Owner/ Less Contractor as Agent for Owner
Signature of Cont r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `,� 1 t tc i
COUNTY OF ` j ii ,tc r2
The forgoing instrument was acknowledged before me
this22- day of0660 .i 20_ff by
The forgoing instrument was acknowledged before me
thi�sZa,,day 20g by
-of/
Name of persortmaking statement
Personally Known ✓ OR Produced Identification
Name of persop making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(SI natu a of Notary Public- to
410 Notary PUCIiC Stets of F101m
Commission No(' ,t ;9� MM¢deSarahBlystone
C-93(dZq� eojCammi86onOG361
�p Expires 08242023
- ( I Lure of Notary Public tate of Florida )
p(
tJissionNO 2/J yM �I}utilt;State OfFlori
, Made Sarah Blystone
My Commission GG 361295
Expims 0a242023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE'
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17