HomeMy WebLinkAboutBuilding Permit Application10- A
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /Q / ! ^r' 7 Permit Number:
i
numing rermit Hppllicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA 1 ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN I LOCAI ION:
Address: --
Legal Description:
Property Tax ID #: U 1a7� /�7" ���s-Q�� -3 . Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DF-SCKIP I ION OF WORK:
L/jte- /O r -A
CONSTRUCTION INFORMATION: -
Additional work oe er rmed un er is permit - check a appy:
HVAC ri Gas Tank []Gas Piping _ Shutters Q Windows/Doors
U Electric 1:1 Plumbing Sprinklers [ Generator 1-1 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
IJ
Cost of Construction: $ /y �� 5l Utilities: Sewer Septic Building Height:
OWNER/LESSEE: _�- —� CONTRACTOR: ,
Nanie Club H" kc -,Name:
CUVCTct7
Address: def& GA"//./Ik&
Company: <` n-rom Lr- Sri S t ervLs 0 -
City: 1 Oaz St Stater
City:
Address: 14' IS 6 E 1./i l ( LLQ -e t' ee iA
Zip Code: L?�IV Y2- Fax:
City: IP0 RT Stt • L u ci e State.
✓�
Phone No. 7U '�G !XXX,
Zip Code: 3H-452.- Fax: 77,2- J35-1ct �-G
E -Mail:
Phone No. T11
Ril in fee simple Title Holder on next page ( if different
E -Mail: C` u S t cti i r Sys �Pcc a 1 C (, vn I
from the Owner listed above)
State or County License: C° C C' S (�
Commencement is required.
If value of construction is $2500 or more, a RECORDED Notice of
SUPPLEM EN I AL CONS I RUC:I ION LIEN LAW INFORMA I ION: i
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone: j
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
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 Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict with any
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,
Thefollowing building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wails, 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
commencing work or recqfding your Notice of Commencement.
i
s
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contrac r/License Holder
STATE OF FLORIDA
E
STATE OF FLORIDA ��
COUNTY OF U C/�
COUNTY OF >�� U C` l
j
The for Ding instrument was acknowledged before me
The forgoing instrument was acknowledged before me a
this iV day of g2e r 20 /?by
'
this 19 day of PCT 20 � % by
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anmvnS
C-urLT1 S gtlmMe) rt S. ,
(Name of person acknowledging }
(Name of person acknowledging) !
(Signature of Notary Public- State of Fi a }
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(Signature of Notary Public- Stat of Flori
OR Identification
Personally Known ✓_ OR Produced Identification
Personally Known Produced
Type of Identification Produced _
Type of Identification Produced
Commission No. CHRISnNEB
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
t
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4358235 OR BOOK 4051 PAGE 357, Recorded 10/11/2017 11:35:31 AM
Permit No.
State of Florida, County of St. Lucie
NOTICE OF COMMENCEMENT
Property Tax ID No. 3 'F a F - 70q-40 ors- opt -3
The Undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this) Notice of Commencement.
Legal Description of property and address if available gey.Mirl R a- etu-b Phd GyAl, PA"o 0 b _
C, R, 597 46 (OR 4.35- 179/ : , 3ij -Z 23)
General description of improvements kW i a-e-� A l �
Owner/lessee � A Jon n4. l., It, b i'j () N � 11 G
Address
In addition to himself, owner designates
Phone #
Fax #
Fax #
of
to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. Expiration date of notice of
commencement Is one year from the date of recording unless a different date is specified. WARNING TO OWNER:
P•N`( PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYSIENT5 UNDER CH.713.13. F.S.. AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS 10 YOUR PROPERTY. A NOTICE OF
CONIK[ItNCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU tNTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN /ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMFNCMENT
Ow Zt"r Owner's or Lessee's AutiortuA Orcrer/Director/Partner/Manager/ Signature
Signatory's Tit1e/Omce
State of Florida, County of
Acipowledged before me this I day of20 l=1 , by fn rah -!>) Lk) I -S
wh is personally known to me or who has produced // as identification,
.1 t-6cpll- L,4,/L STD r/ a t' t `fes
ign ture of Notary Type or Print Name of Notary (Seal)
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e: Notary Public Commission Number lOgl pH t AR0ON +,artFv
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Interest in property: Owner
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Fee Simple Title holder (if other than owner) /g
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Address I cPI S O LL R,°C ogteS l,/ 1)P—
Contractor 6tt-, 7 -Dig Rett
Phone#
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Address m -r SST . 1-4,eiE FL -016A
Fax#
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Surety
Phone It
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Address
Fax #
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ID 0 0U
Amount of Bond
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Lender
Phone #
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Address
Fax #
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Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
prdvidi Q
by Section 713.13 (a) 7., Florida Statues:
Name ,j //}-
Phone #
Address
In addition to himself, owner designates
Phone #
Fax #
Fax #
of
to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. Expiration date of notice of
commencement Is one year from the date of recording unless a different date is specified. WARNING TO OWNER:
P•N`( PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYSIENT5 UNDER CH.713.13. F.S.. AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS 10 YOUR PROPERTY. A NOTICE OF
CONIK[ItNCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU tNTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN /ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMFNCMENT
Ow Zt"r Owner's or Lessee's AutiortuA Orcrer/Director/Partner/Manager/ Signature
Signatory's Tit1e/Omce
State of Florida, County of
Acipowledged before me this I day of20 l=1 , by fn rah -!>) Lk) I -S
wh is personally known to me or who has produced // as identification,
.1 t-6cpll- L,4,/L STD r/ a t' t `fes
ign ture of Notary Type or Print Name of Notary (Seal)
i3 G / o q sl 2- .�..._
e: Notary Public Commission Number lOgl pH t AR0ON +,artFv
MY COMMISSIONIII G(37MI2
EXFIkES Way 9U, 2021
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