HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �t G
Date: 3 e`\, \g9 SCANNED Permit Number:
® BY
-' = '`_- ' St. Lucie County RECEIVED
Building Permit Applicati n MAR 21 2019
Planning and Development Services
Building and Code Regulation Division _OT'_ �tl�i@ §ttn€y, PLI`ry9l€ting
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line C *f.% III
PROPOSED IMPROVEMENT. LOCATION:
Address: 3'761D AquE F JET' piEaee t G , 3y9y7
Legal Description: �rJ� G�4 t Fa%eS os3j- �(o
Property Tax ID #: '2404 - ivv$- bi cf - ' 'I Lot No.
Site Plan Name:
Project Name: It 1i951-1 J9(,�, %5 OC;:17 ae
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Block No.
T✓lS{��� 'LO3r
a-F
6 rl7t;5
4
W1(3)s'7i4'4s
V1 b z�1L.O L ;re d
c2)
z0 f"-
L I
des.
CONSTRUCTION INFORMATION:
ACIditional worK to ,Ie_p_e� ormed under tispermit-check all apply:
�HVAC LJ Gas Tank ❑Gas Pip fn Shutters ❑ Windows/Doors
Electric Plumbing Sprinklers Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2 qS & O
S Ft. of First Floor:
Utilities: 0Sewer DSeptic Building Height:
OW Nf R/LESSEE:
CONTRACTOR;
Name''T0N Arlo- Pl";e 01114i j
Name: _Ak*rG",ae-•/ .T 1J4Idf�ro
iAddress: 3`cro 1406 /^.1
Company: tNtJ'e'vR to Co�-rto�13
City: �P'r Pie'c-e State: t_G'
Zip Code: Ki Fax:
Phone No. OIC�f - Lf
,Address: Fbaw= 121 S')
City: ;ele-YP/'t rGt� State: )Q-
Zip Code: Fax:
Phone No. 7 7 2. i/ti. 91� g,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: M W 41JroP (F d-NN o u 4+"',1
State or County License: CGC 1 C'/I 9/ D
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENzLAW 1NFORMATIO��`��Y�`�
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:
_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 County makes no representatioh,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 rec ed and posted on the jobsite
before the fir nspection. If you intend to obtain financing, consult wi ender or an attorney before
commencin work or recordingour Notice of Commencement.
Rev.8/2/17
Si ature o Lessee/Contractor as Agent for Owner
- ture of Co ractor/L' _ _
STATE OF FLORIDA
COUNTY OF ST GvG/�L
STATE OF FLORIDi��
COUNTY OF ST G�G;�
The for o' g instrument was acknowledged before me
this ayofh .20,[I by
The forg Ing instrument was acknowledged before me
this�dayof�,q�"GG .20� by
�e h � 1 ✓_ /,> a (�r.-gyp '
l71 iGGt.� Gi ✓.
Name of person king statement
Personally Known person
Produced Identification
Name of person m�ng statement 'r
Personally Known !/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur� Public -ate of Florida J
(Signature of Notary Pub -State of Florida )
CommI551on No. y (Seal) KRIStt SEXTGN
Notary Public •State of Florl
Commission # GG 708744
Aly Comm, Expires Apr 17, 70
mmission No. �'ta`r °ri'•:, ($kaI�ISTY SEXTON
a �+ NotaryPublic -State of Florida
'v
' " •- Commission # GG 208344
Ih°�'� My Comm. Expires Apr 17, 2022
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