HomeMy WebLinkAboutBUILDING PERMI APPLICATION1
All APPLICABLE INFO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �g TO SCANNED Permit Number: jgos.cn o
BY
Lucie County
- - -- - -- 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'x Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:.,
Address: 290 SW Primavista Blvd Port St. Lucie
Property Tax ID th 3429-134-0001-000-5
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
CONSTRUCTION,` INFORMATION:.
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric 2<Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
� J Cost of Construction: $ /0o Utilities: ✓ Sewer _ Septic Building Height:
OWNER/LESSEE;, 21
CONTRACTOR
Name Bishop Gerald M.Barbarito, Diocese of Palm Beach
Address: PO Box 109650
Name: Joseph P Marsala Jr.
Company: Du -All Sewer $ Drain Service Inc
City: Palm Beach Gardens State: FL
Zip Code:33410 Fax:561-775-9584
Phone No.561-775-9514
Address: 514 S. East Coast St
City: Lake Worth State: FL
Zip Code: 33460 Fax: 561-753-3432
Phone N0561-753-3446
E-Mail: mlockwood@diocesepb.org
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail duallsewer@aol.com
State or County License CFC 1427336
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION, LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." 1 /1
p
Signature of Owner/ Lessee/Contractor as Agent for Owner
rSig u of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLOR A n
COUNTY OFPal.Bea=h
COUNTY OF �p� Ul 11( 0.
The forgoing instrument was acknowledged before me
The forV. instru�gnt as acknowledged before me
this zBra day of May 20_ by
this �X day of WI C 20� by
Ni i ChatA Lo Lwouc
JPA (M"Lk .
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known v/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
L2,.
DESTINYRGIBBONS
(Signature of Notary Pu lic- Sta e, a1NMDEFLv t 9000R
(Signature of NotaryP 't- 'dioA#GG27
XxPitees With 31, 2021
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Commission No KZVE"o'Z°O�° L
Commission NoAr� (Seao(PIRES June 25.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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