HomeMy WebLinkAboutPermit App-St. Lucie CtyALL APPLICABLE// INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L4 — e - (E
Permit Number:
Building Permit Application
Planning and Development Services
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION'.
Address IbiF�S 5 c 2. -I S-� l eL 3t-{CI,'L
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Legal Description:
Property Tax ID k: Lot No.
Site Plan Name: Block No.
Project Name:
Setback, Front Back: Right Side: Left Side:
DETAILD DESCRIPTION OF WORK:
�1�1-5 In clan e.e`,�M Su..U(izh'
T
(L�iiCyc (.f Cs FGA o..-I'lo_i-S �rt Jc •r�4Ge -A, new crrc�.
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CONSTRUCTION INFORMATION:
Aaanional work to 0iIa� p'�eIrorme un ert is permit -cracka appy:
uGas Tank Des Piping _Shutters Windows/Doors
In
IIO�HVAC
R1Electric ElPlumbing ❑Sprinklers 1:1 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer Septic Building Height:
WNER/LESSEE:
CONTRACTOR:
Name:, 1 o5e_,-, -�' � cs ese
Name �,4„Lrn �(n nite C_
r
Addess:�olb S' s IaSS t..
Company:
City: a,+ C—�e State: ILS
Address: (oErtfr rpr Ls,. ��. (
Zip Code: 3 N9 f (e Fax:
'rCt'cl
City: L(,* S -f- State:yy
Phone No. C%12--`7 f c?—S63z
Zip Code: 344q 8(e Fax:-172-1Nrt-5_lot
E -Mail: DFl_ .nr e_ cs') C e-"Cc9+ i<_+
Phone No. *1-)2.
Fill in fee simple Title Holder on next page(if different
E -Mail: Lg(2noye Sec,>4raX-kane.( ecteet-.ebb
State or County License:C G (3 00 33c. (3 00 33 1�
from the Owner listed above)
Ce w% Ce, #
If value of construction is $2500 or more, a RECORDED Notice of Commenceme tis required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
COUNTYOF S'C-L..c,
Address:
The forgoing instrujnent was acknowledged before me
City:
Zip: Phone
State:_
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Produced FiOL
Address:
(Signature of Notary Public- a g.v • orida )aAti1�mQsx F&co
City:
if.SppdFlM4a
ommission No. CW (SeatJnamAGGOBdiB1
City:
d'
,Pg MiCa^m.E�Jresxr N.2ttt
Zip: Phone:
FRONT
Zip: Phone:
SUPERVISOR
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 Dermit 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
commencing work or recordine vour Notice of Commencement.
Rev. 8/2/17
gna r Lessee/Contractor as Agent forOwner
SIatu of Con ractor/License Holder
STAT F OggI�ppA
ST OF FLORIDA
COUNTY OF 5't-L-cL
COUNTYOF S'C-L..c,
The forgoing instr rent was acknowledged before me
The forgoing instrujnent was acknowledged before me
this day of ,� 20l by
this�day of ff-o��l .201?by
Uptepvs Al,
A!. Ga40LAe. —
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification A
Personally Known OR Produced Identification >—
Type of Identification
Produced 170L 6-54-4gH-%3-AsM-6
Type of Identification
Produced FiOL
(Signature of Notary Public- „ n a
•....,oµ4RNEW IDAM FPLCA
(Signature of Notary Public- a g.v • orida )aAti1�mQsx F&co
in+
Poblic-Sa'eolFdiEat�ssyy'�
Commissbn #i:K
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if.SppdFlM4a
ommission No. CW (SeatJnamAGGOBdiB1
` Cnmm.Erores Mall. ffi1
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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