HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICAB -E INF9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Ip )
Date: ! SCANNED Permit Numb r
BY
St. Lucie Countv
• Building Permit Application JAN 2 2 2019
Planning and Development Services
Building and Code Regulation Division Permitting Depar men
2300Virginia Avenue, Fort Pierce FL34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial R to
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Lot
Site Plan Name: Block No.
Project Name: 6l A I c, C 05 Pr i ff c Scam F 1 g S+cn hS .
Setbacks Front Back: Right Side: Left Side:
DETAILED DE"PTION OF WORK
PqC) 10c Co 161GCn Mai' 111r' h . SI-Y G i h
r,o ,gcks: vz t Ppop z_,.�E a+� r w17 7� 1 ,
sciocl,r4& 'Tt,e_ /Wo PIAOMaAGs
HVAC LJ Gas Tank Ln�(Gas Piping
Electric Plumbing []Sprinklers
5hut ers Windows/Doors
Generator O Roof = Roof pitch
Total Sq. Ft of Construction: ii- K $ S Ft. of First Floor:
Cost of Construction: 1 23�° Utilities: 11Sewer DSeptic Building Height:
OWNER/LESSEE
CONTRACTOR
Name
Name
i
r
Address:
Company:
1
F
C
City: State:
Zip Code: i . Fax: r�H 1
V
Phone No. — — l
Address: ' l
l
City: f-ssl--�
Zip Code:
Phone No.
State:
Fax: 1Q—G
E-Mail: I' m i5n off ncet� -YAP }
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: e •
State or County License: C7
0p
X^ � OyGCS .
If value of construction is $2500 or more, a RECORDED Notice
is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: hone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA g fWr( Cove COUNTSTATE OF FLORIDA
COUNTYOF COUNTY OF
The forggoing instrument was acknowledged before me
this a day of _�w� 201-9'by
person
Personally Known OR Produces ISEF t# •� flboq�
Type of Identification P duced�e
Commission No. ova ua� �*(Seal)
Revised 07/15/2014
The forgoing inst ument was acknowledged before me
this L day of� 20 L%by
r
(Nam o person a 3ncknowwlledgiin )
(Sig�of Notary ub' - tate of Florida ),,,,,,,,,,,•
Personally Known Xj_ OR
Tvoe of Identification Produce(
No.
cgv. n:rc:•r.:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
I
INITIALS