HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,1
Date: Permit Number:
RECEIVED
Building Permit AppliEatioAJN 14 20'8
Planning and Development Services ucie County, Permitting
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: Q� av� (iY�o$►L� �.�, ,�
Address: Cn S,-t-J L1xc.S c e'lspr> EL PL- r4� F-L 31f,115-1
Legal Description: SvRkNtSkl� if i
Property Tax ID#: 1301 (l (�lY)I DO5S� Lot No.
Site Plan Name: 5 ��Z �` Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ETAILED DESCRI
Ow WLOOLUG K `—
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 Pitch
Total Sq. Ft of Construction: 1 -200 Sq. Ft. of First Floor:
Cost of Construction: $ "7#-&V - U'O Utilities: —Sewer —Septic Building Height: 1 SSD
Name �ob�azc' MoSiLGv Name:
Address: to S� LL,-Ls �AiSPD Company: CAsTyL,:� V Lc c--
City: F PLtpzzC State: L Address: 32.Z\
Zip Code:3q�S-1 Fax: City:Fi PcState:r�
Phone No. )_9_3 16 Y3 Zip Code: 3�L19S5 Z Fax: -2-7 z, `fib l-10 i�r
E-Mail: Phone No '1'7-2- ZL(, --,f-6tf-1
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License cecossS�3 J 10 &`1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
ININIFTIN MU1_""VN1atr YRIWA I IV r4w_
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:
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 y�tr
rty. A Notice of Commencement must be recorded and d on the jobsite
before the fir iyou intend to obtain financing, consult ��len r an at before
Commencin rkn otice of Commencement.
Signf caner/Lessee/Contractor as Agent for Owner Sign e o Contractor/Lice oder
,atwiSTATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6 . COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledge before me
this�day of 'Sy r-Q 20 1� by this day of 5 V Y%-a- 20�� by
SA <Ja �a6�o d. �t•� �r Cas�ar.�u�3
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif' ation Type of Identification
Produced V Produced V't- ID t_
(Signature of Notary �S f' ff�tt�C�aa� �IEGNENs (Signature of Nota ublic-State of I
ludNAM ' 072025 D Y I SIGN#GG 02207.3
Commission No. R1Y c $ nber16,2020 FIRE err,ber16;�2020
�XPIR. les 1 Commission No. `— g G j rhn(Seal) ', Underwrimra
a, b%;Underwr a
•,, Banded ihru F,otary P"
r �Ucf,.•, .s..+..v.ci'..w&,a..�VWi![�na++iwY,.+++�pa�Ysro`..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17