HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (f-- - Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Application
. X . NT LOCATION:
Address: $10Vd
Legal Description:
Commercial Residential
Property Tax ID #: 30 1 - to f I - Q ,;�0Q - co c) -- S Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK; _
u�
!TION INFORMATION:
itiona wor c to to iJe per orme un er t is permit - c ec a t at
LMechanical — Gas Tank —Gas Piping
Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $J ac)(-). 0 C-)
Name 01 4- DG1 Un Brad
Address: -] ( 0 3 () Or-:: -� 19jI VC1,
app�—
Shutters
Generator
Sq. Ft. of First Floor:
Utilities
City: _V�_n ( 4-- 1)1 el-ce- State: F --L
Zip Code: 3 y 9 S i Fax:
Phone No. -1 L{ -
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Sewer _ Septic Building Height:
Name:]�� )� —
Company:C(
Address: CCtbGnc�_ LonQ
City: PQlr ' �trC�c State: -P --L-
Zip Code: 3L19 S I Fax:
Phone No 1 -1 0- Lf 'S - 0 L
E -Mail CLLXD I cL I ,Cl_fly, . Com
State or County License } 9 ()CJ
If value of construction is 2500 or 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 attorney before
commencing work or recording our Notice of Commencement.
Signatur f Owner/ Lesso/Cdntractor as Agent for Owner Signature o Contractor/Likbn Holder
STATE OF FLORIDA ! D STATE OF FLORIDA
COUNTY OF S � C1L.�-G COUNTY OF 5t._"
e
The f0rigging instrument was acknowledged before me The for�c�ing instrument was acknowledged before me
this ay of 2� by this � ay of 20A by
S6. A M 1791 1
(Name of per n owledging (Name of persona nowledgingl
(Signa re of Notary Public- St e of Florida } (Signatu of Notary Public- State 4f Florida j
Personally Known OR Produced Identification Personally Known OR Produced IdentificatioK'_"Pmr�ac
Type of Identifi ti n , Type of Identif- ation _ t y — Frtrh P
Q Erich Daniel Kra h ( ,, N s f ' i Ca LIC
Produced r�� AM 4 -ss Produced
NOTARY PUBLf STY' �Tk OF F1.ORIC1
L� aSTATE OF FLC EDommission No. �e�al n'4 �,G15925
Commission Na. y Comm#GG105 215 } xpir 51"171202
1=.xpires 5117/2 21
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 4
DESIGN ER/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:
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 attorney before
commencing work or recording our Notice of Commencement.
Signatur f Owner/ Lesso/Cdntractor as Agent for Owner Signature o Contractor/Likbn Holder
STATE OF FLORIDA ! D STATE OF FLORIDA
COUNTY OF S � C1L.�-G COUNTY OF 5t._"
e
The f0rigging instrument was acknowledged before me The for�c�ing instrument was acknowledged before me
this ay of 2� by this � ay of 20A by
S6. A M 1791 1
(Name of per n owledging (Name of persona nowledgingl
(Signa re of Notary Public- St e of Florida } (Signatu of Notary Public- State 4f Florida j
Personally Known OR Produced Identification Personally Known OR Produced IdentificatioK'_"Pmr�ac
Type of Identifi ti n , Type of Identif- ation _ t y — Frtrh P
Q Erich Daniel Kra h ( ,, N s f ' i Ca LIC
Produced r�� AM 4 -ss Produced
NOTARY PUBLf STY' �Tk OF F1.ORIC1
L� aSTATE OF FLC EDommission No. �e�al n'4 �,G15925
Commission Na. y Comm#GG105 215 } xpir 51"171202
1=.xpires 5117/2 21
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 4