HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /�— G Permit Number: RIECEIVED
Building Permit Application NOV 2 9 2ols
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Planning and Development Services St. Lu<:° . •��,.,,-.
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1_
PERMIT APPLICATION FOR: �Q4C'Y- � -�_ _- e, - I
PROPOSINPRO EMENTLO°CATION y
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Address: r G i ii `'fie 72 /2-j 3 '57 992
Legal Description: �l�d�%G� %ucy G S �� - ���� - �1- LAK 71-L G�`
Property Tax ID#: 3 /0 GC S 6 —BGLot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRt£JC�TIO�N INFORMATION k �u e
Additionalwork to be performed.._ under this permit-check all that apply:
_Mechanical _GasTank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Q�U11'NER/L�ESSE � k' ���CONTR�AC�TO�R;
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Name � c�9 t'i' Name: J-ay,, e
Address: EGG - f_�C2f'e-- /0Z2CZ Company: AZ2�_,e /1/��oL
City: C-), I S -4 e,--/'o Stater Address: Z;2 Z 21/1
Zip Code:� •�G/ Fax: City:/� State:�=/G(
Phone No. ,� 7G —6'>;/— 309 Gf5— Zip Coder Fax:
E-Mail: Phone No 7Z2 - 30 - 9 /G c:7-
Fill
Fill in fee simple Title Holder on next page (if different E-Mail z�e-el )P2 4 0-
from the Owner listed above) State or County License t``/= C' 1 l Z
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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:
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 thepermit 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
commencinR work or recording our a of Commencement.
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SignaturLWeWitractor as Agent for Owner gna ure o o ac or/ i ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k- LJ c 1 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this oL day of 20\_!�k_by thisZA day of 1�idJ20 �o by
-k f �,+z y. �e �1n L�� P P 0,
(Name of person acknowled in ) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identificatio Personally Known OR Produced Id
Type of Identification Produced �6. ENS Type of Identification Produ EGIVEN
S\OA#GG 2020 :„"N•~� Y COMMISSION 82020
Commission No. �J �0\S ��bet% -_.W'tore � ommission No. - , -� p � 8�]bb kUoderv+ n
3 ';K F1�5O NQ°b11a� ; Kotary
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS