HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (o " I - l 1 �O
,ILf--CI
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number:
Building Permit Application
Address: L � e
Legal Description:
Commercial Residential
Property Tax ID #: q Q.kr -C) Lot No. C �eLi _ (� (�` �� -
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
V V-0 "e(0-
ditionai worK i
L-iviechanical
Electric
,tormeo urn
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $ eE�C' 161 - b Z'
permit – cnec
_ Gas Piping
— Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Name 0C11her�(l�7_�i��1�
Address:_yl�
City: P state:
Zip Code: a e� Fax:
Phone No. 'Z� - �UO J Li
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ( Urtl5 ' aC Vlmon s
Company: A t'c r -1 -IL
Address:
City: Po_State: >cL.
Zip Code: J2J Fax: ' 7; 33S )ILL—
Phone
iibPhone No. 77� 33,5 3 3 2
E -Mail:
State or County License: Gfl C D 5 ►lO �a�
If value of construction is 249l0ror more, a RECORDED Notice of Commencement is required.
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 attornev before
commencing work or recor"g your Notice of Commencement.
Signature of Owner/ Agent/lessee I Signature of Contractor License Holder
STATE OF FLORIDAC 1 Loc
t� STATE OF COUNTY OF FLORIDA �4- Luc
` Q
COUNTY OF JT l�.X'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1a day of . � ane- , 2016 by this _LJ_ day of —L3rU = , 20ik by
6Q M MO Cly Cur-�%'5
�a YYlYY10 �" 1�J
(Name of person acknowledging) (Name of person acknowledging)
i
(ignature of Notary Publi tate of Florida) (Si nature of Notary Public -to of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced_
Commission No. FF 'A2.1 .5 q 5 (Seal)
DEBRAL
Personally Known ✓ OR Produced Identification
Type of Identification Produced_
Commission No. Fr- (Seal)
ion",":.°;'°i�, DEBRALJO(#•5.,
�' E)TIRB: ember '2o19 RI3:Septw&5,2019
REVIEWS FRONT ZON
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
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 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 attornev before
commencing work or recor"g your Notice of Commencement.
Signature of Owner/ Agent/lessee I Signature of Contractor License Holder
STATE OF FLORIDAC 1 Loc
t� STATE OF COUNTY OF FLORIDA �4- Luc
` Q
COUNTY OF JT l�.X'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1a day of . � ane- , 2016 by this _LJ_ day of —L3rU = , 20ik by
6Q M MO Cly Cur-�%'5
�a YYlYY10 �" 1�J
(Name of person acknowledging) (Name of person acknowledging)
i
(ignature of Notary Publi tate of Florida) (Si nature of Notary Public -to of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced_
Commission No. FF 'A2.1 .5 q 5 (Seal)
DEBRAL
Personally Known ✓ OR Produced Identification
Type of Identification Produced_
Commission No. Fr- (Seal)
ion",":.°;'°i�, DEBRALJO(#•5.,
�' E)TIRB: ember '2o19 RI3:Septw&5,2019
REVIEWS FRONT ZON
�dti 6�d$EMR "LANS VEGETATION SE*,+ E 8wedWNWQ@M1yIm
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED