HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SCANNED Permit Number: L-1 �)�-p Dale 1
BY
o -i-- 't. Lucie County RECEIVED
Building Permit Application MAR;2 3 10i9
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lude County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ' Residentiar
1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRC!POSED iN[FROUEfV(ENT1L'OCATION
ik
Legal Description: CZ_
Property Tax ID N:-3�c�..�� - �C _��— CXY���— n[^�'� Lot No.
Site Plan Name: Block No.
Project Name: 'I - PA
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIPTIONrOF
t..
��Pce-'e?F•:����q Cp_oa�a�o�ge� c�� `..%lo�i.`
CONSTRUCT(f1QN_ INFORNtiATION
Additional work o br1ormed un er Is perm) -c e
�❑HVAC []GasTank ❑Gas Piping _Shutters ❑Windows/Doors
I_I((Electric 1:1 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer Septic Building Height:
OWNER/LESSEE '' :'
of structl
CQNTRACTOR i
Name:
Address:
city: �p���, `� State•A.
Zip Code: ��'Fax:
Phone No.
Compan
Address:\�l
City: �� 4cc_ State.`'--L_
Zip Code: ?ems Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
tl valuo
E-Mail:
State or County License:
Iicon on Is s2500 or more, a RECORDED Notleo of Commoncament is required. II
fti
SUPPI EMENTALCONSTitUCf10N L1E�1 LAIU INFOFtlVlA710IV
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State: _
City:
State:
Zip: Phone
Zip: Phone:
_
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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.
SL Lucie Count makes no representation that is granting a permit will authorize the {5ermit holder to build the subject structure
which Is in con Ilct 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 followingbuilding 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•residentlal 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.workor recording our Notice of Commencement
Signature of Owner lease 'ia., s`Agert for Ownp
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF ir [��
STATE
STATE OF FLORIDA
COUNTY
r ,-�
OF 't PJ�QS
The fo oIng instrument was cknowledged fore me
this, day of�(D/ ZO
The for oIng in ent was acknowledged before me
y
this,/dayo�20J9 by
Name of person m ' g statement
Personally Known OR Produced
Name of pers making statement
Identification _
Personally Known OR Produced Identification
Type of ldentification -
Type of Identification
Produced `I E•�C Atant PuckState ofFlorida
—N
Produced
Jennifer R Ranneburger
My Commission GG 227212
r,i:
exPlfei 1:2022
_ {-
(Signature of Notary u I c-State of lorida
(Signatu� of Notary Pu Statoridall
-A MELISSALE
.: *COMM16=NS
Commission No. (Seal)
Commission No.
E7(PIRES: December
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112A(
DATE
COMPLETED