HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: a 12 Permit Number: �J
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Building Permit Application MAR 2 S
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Planning and Development Services St. Lucie CPERvii-; Ijgy
oun , FL
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:
PRQ ®'SED INPROu�E�MI NT LOGAaT'O1N. _C
Address: to?7 Qy�c�I`JS�� "OV, ftere-c `l Owl
Legal Description: "et.ncr Cott Y yini 609 Lo/ 10,
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Property Tax ID#: / 7ml- 70/` 0/ '73-Da0Lot No.
Site Plan Name: Block No.
Project Name: h
Setbacks Front Back: Right Side: Left Side:
QETA:FL D Q�E� C'RI�PT ON OF ' 0 � :
C AL v D GXah
I=UCTION FNF®Ri ATI®N:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters =Windows/Doors
_Electric _Plumbing _Sprinklers . _Generator _Roof
Total Sq. Ft of Construction: / Sq. Ft.of First Floor:
Cost of Construction:$ /t�0 Z tl J Utilities: —Sewer —Septic Building Height:
Name_ npleS &,orrJ -4h Name: AAV7,WJ
Address: 12 7. veeAJ y Company: G64VI.V " CP / J
City: /� ., �jG/ca State:F7 Address: f .. f �d46o
Zip Code: c7i/9 4/9 Fax: A.-44 City: /4"tle'< State:_&n
Phone No.15/1-SSS-15 /3 Zip Code: 3"yg� Fax: 77d.eldl.
E-Mail: 4,r I'd Phone No -77.?- V46
Fill in fee simple Title Holder on next page (if different E-Mail ®®0 V G'
from the Owner listed above) State or County License .S'GCl3//•�I•S�D
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR+IJCTI®N LIEN LAW INFOR AT10'N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name.:
Address: Address:
City: State: City: State,
Zip: Phone Zip: P one:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: V, City:
Zip: Pho e: 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 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 restriction's which may apply.
In consideration of the granting of.this-requested permit,] do.hereby agree that[will, in all'Tespects; 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 aind accessory uses to another non-residential use
4
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
commencing work or recording our Notice of Commencement.
ignature of Owner Lessee/Contractor as Agent for Owner ignature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLO�`DA
COUNTY OF -�_LceCj COUNTY OF (-- L'WL
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of rC�. ,207 by this_3day of 20 i by
rho d S (GkA-`0 CC
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-.State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification t�
Type of Identification Type of Ident' ication
Produced fio" _ oduced V10r
:�osPar°bay;% SUSAN A.BOWEN .°'aYP�' SUSAN VBOWEN
Commission No: . ?* * = Ng�►)Public-State of Florid mmission No. ;�_°�» *�"': Notart(�91)-State of Florida
r _
Commission#FF 231072 ''" ;Qe Commission#FF 231072
�';FOFc�q•'�. My Comm.-Expires Jul 28,20?9 ,, '%'9f pc m.Expire Jul 28,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI . ISINTU TLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.7/203.4