HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/1-7119, SCANNED Permit Number:
BY,
St. Lucie Count,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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
PROPOSED IMPROVEMENT -LOCATION
Address: 6 11
N1 �wM
Legal Description: YaI (M_
�� l�
Cat —1-• 131 K-1 N 64 P 97 i 1 0 E
R2s�
' 1 �1
tt-I' PropertyTaxlD#: a5`Iol O 0ao Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DEkR'IPTION_OF ORK , ....a
Tnsic-kVowdbws pk_� l04 a, 1 axe -eftb- 60>;s
CONSTRUCTION•INFORMATION;
-- • - -
Acartiona wor tO e e orme under this permit—Checka apply:
1JHVAC �GasTank ❑Gas Piping _Shutters EI/Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
I Height:
Cost of Construction: $ I�yy r Utilities:Cn Sewer[] Septic Building
OWNER/LESSEE..
CONTRACTOR:.
Name
Name: �r r�
Address V�j 4 (�
� E
Company: 5 Ai� UP
City; 'P-' 'P ) f- Lim State:EL
Address: TD p2 - q
City: oy L Q D state: )
Zip Code: 3 �ffl N Fax:
I _
Phone No.J7r2--,49-E50LP(P
Zip Code- a —7 Fax:
E-Mail: ^�
Phone No. —ria`46,3—�'o2g&
Fill in fee simple Title Holder on next page ( if different
E-Mail: t L Y_P
State or County License:
from the Owner listed above)
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
WE
-SUPPLEMENTAL ON LIENIAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 1 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 resuINn your paying twice for
improvements to y r roperty. otce of Commencement must be recorde an poste the jobsite
before the first ins ect on. If u in end to obtain financing, consulYwith len r o an a me before
rnmmanrinv wnr nr r rnr a vnu Nntice of commencement. 1
Signature of O er/ Lessee/Contractor a Age t for Owner
Signature of Con r ctor/License Ho der
STATE OFF ORIDA
STATE OF FL RIDA
COUNTY O rct o
COUNTY OF u
The forgo in rum�pf,w,,,,as �acknowled a before me
The f ing' strument was acknowledge efore me
rda Q l 20 I_ by
this da o �y 20by
thisof ��
ll
Q,r- A
Name of person making statement
Name of person making statement
Personally Known vC OR Produced Ident' c on _
Personally Known — V OR Produced Identificati
Type of Identification
Type of Identification
Produced
Prduced
( ignature of Ne ary Public-S a e of FI
a I'�c�f Iyr'
r-yl'
oto`°0.Y 0`Oa Notary Publb nGg�F�9ride
aCommission
Y w• Notary Publte � �e'of FJ�e81)fi
My Commission FP 981647
0628/2020
My Commission 20 981647ov
Expires 06/2812020
odao Exprtes
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.g/2/17