HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO'BE.ACCEPTED
Date: (r ' 1 SCANNED Permit Nu
BY RECEIVE®
St. Lucie County
SEP 6 2019
Building Permit Appl cation
Planning and Development services ermItting Department
LucieCounty, Building and Code Regulation Division St. FL
2300 Virginia Avenue, fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial �L Residential
PERMIT APPLICATION FOR: "J�r'D
Rya°"' a ._� � • •O�l���w ®�� I,O Q
Address: 3IL3 L t�M1�o�.SD l�0Wt, 1=°PZT- PIL�;:-2c-Lr
Legal Description: 30 3 40 S Z 00 I-T- O L M 24S ` 0 11 ([2- D E I i E 1/4 6 F S,4
V4 - I --III R D QW AOD LIIS RS! hi OIZ 45R-2VS(o65 zo���(or2 3734- Z525)
Property Tax ID#: 3 11 - 000 00 /s Lot No.
Site Plan Name: C*,eLl^S4L.0QXIZx Block No.
Project Name:
Setbacks Front 1 two ` Back: Sl Right Side: iZS' LeftSide: 3-o'
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1Mp n RION IN INEM
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Additional work to be perrormed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
/'Electric _ Plumbing —Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: S2 F Sq. Ft. of First Floor:
Cost of Construction: $LJi 00� Utilities:n —Sewer _Septic Building Height:
Name,vy�l k 00 Nti A 1'WATs � IE12U lUi bxle-
'-Name:
Address: 3'I lD t)l&
Company:
city: R,%zx pt i =>u t= State: li`
Zip Code: 349 4G Fax:
Phone No. ALZ- 2 3 ct �
Address. f
City:12r 4 ),-Oe6 c, II Stater
Zip Code:, �C%�? Fax: L16 S —/ U Io 3
E-Mail:
Phone No 0
Fill in fee simple Title Holder on next page ( if different
E-Mail D d r
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Na
Ad
Zip: l Phone:5a. 1A,?2- f f
FEE SIMPLE TITLE HOLDER:. INot Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
City:_
Zip: _
_Not Applicable
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rommpnrino work or rprordine vour Notice of Commencement.
__......_... - - --- -- /
Signatur Owner/ Agent/ L ee/ ontractor
Signature o Contractor/LLiic`ense older
STATE OF FLORIDA r-� `� n
/ /, ,� J
STATE OF COUNTY OF.17 /�/
COUNTY OF ,�-`7— o
The forgoing instrume t was a nowledged efore me
The f r oing instru ent s acknowledge efore me
day 201Tby
this 0Q day of 1 11 20 by
thi of
A
15 A Fi2T A✓
(Nam er in acknowl gingJ
(Na rson ac ledging )
C
(Sign ure of Notary P e of Florida)
(Sig ture of N ry Public- tate of Florida )
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of IdentificatioW
Type of Identification
Produced
- ' SHERRIFEHLh1AN
Produced
SHERRIFEHUVX
?o1'pvrue�1,
Commission.No. , ealf_mmission#GG1S71
EzpiresMarch14,20-
Nf'rFOF
�aoarrue�c
Commission No. „ (GW)ssion # GG 187160
Ezpires,March14,2022
F`oQG 6ontleE itru Budget Notary
922
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lFOF pO Banded Tta 81" No" 81&1
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DATE
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DATE '
COMPLETED
Rev.7/2014