HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(
Date: J • 1�A • 1T— SCANNED Permit Number: U
®,.... BY
St. Lucie County
Building Permit Application LK L VED
Planning and Development services 14 2019Building and Code Regulation Division2300 Virginia Avenue, Fort Pierce FL 34982Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Rnty, permitting
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMFROUEMEI0L'OCATION:: F
Address:
Legal Des
Property Tax ID #: 14 2 -5 2 Q • OW 1- 0 1® • 1j Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
wow�istin� CcimrneXaa� C�1, �n��� '�� Mwr
Juu,une, warx co De errormea unaerims permit- cneCK a
11HVAC _Gas Tank ❑Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3j�. s-GO • CDO
Shutters ❑Windows/Doors
Generator F—] Roof = Roof pitch
S Ft. of First Floor: _
Litilities:Sewer OSeptic
Building Height:
ODUNEI2jLESSEE: ""
CONTR?CTOR
a-
Name,t"y�f1- A o
Name-* Ifoa-
�/A
Address: _ r (16( �{,Ij� z
Company. I-os ? /Parfli
City: rC2�rS ixa, Stater
Zip Code: Fax:
Phone No. Z&6-e�3 52
Address: V 1, 38 0,&c Y r
City: Vef7) &add Stater
Zip Code:-7:U910 2 Fax: 7 2-a/7Ac2,7'3
Phone No. 77.2- ,20- 4,
E-Maih -�//YAAn/7UA1,1 'ml 26t IT/, &044
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: C; f t
State or C my License:
it va,ue or construction is $zeuu or more, a RtCORDED Notice of Commencement is required.
S1)FPL�MENTAL CQ�1Sl"ItUCTION
LIEN.LAU1t (NFOftMATION �_�._'r
—
DESIGNER/ENGINEER: _
Not Applicable MORTGAGE COMPANY:
�t
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State: City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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 Count yY 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 Commence mast -be -recorded and posted on the jobsite
before the first inppection. If you intend to obtai ncing, consult with lender or an attorney before
commencing wok or recording vour Notic ommencement.
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Signa re ner L sse /Co ra or a gent for Owner
Signa r Contractor/ ic�-e Holder
STATE OF LO ID)
COLIN OF
STATE OF FLORIDA
COUNTYOF
The f going instrument was acknowledged efore me
this oZ/ day of 20 )�by
The forgoing instrument was acknowledged before me
this o� day of Tel^ 20�by
/Gn
l�n /S X
C can �'1t'i3� L t
Nary% of perso aking statement
Nariie of person }aking statement
Personally Known OR Produced Identification
Personally Known r/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
/,�y
1'ry/I� X
(Signature of NotaryaC M LLS
Commission No. commissio�,228285
es
MCC
Cj�r�pL�LFS
(Signature of ! tary P ' IQ5eolenilmr
Commission No.�1smdrTs fdh 22BZ.85
4 20 9e5
Seotem er 4 2019
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17