HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ili 24//1 Permit Number: /• f (' o57
r t• ' ." '; RECEIVED
Co Li IN Y a`'
--- _ R --- � 4 NOV 2'9 2018
{ Building Permit Application
Permitting Department
Planning and Development Services St, Lucie County I
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone:.(772)462-1553 Fax:(772)462-1578 Commercial . Residential VVV
PERMIT APPLICATION FOR:
,T-,1-
''.-1---47v--4.4--, -.
47M: 4a, T _ c
t� 'e - >
g; - v-- --, ' ,s5 R S+' • : x —.. at,V:tvp,', . gi!• � txi _ T,
Address: 1 U q ci.1- co Avk br 1 -?:-O-C-t
- 71 ‘3//q8).
Legal Description:
Property Tax ID#: 3Li oc - 1/3 - ddOa - daO- S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
' it_ l cnA\ Rml Gly CL (7 -Qs 4 ,r Q V.0 u S P
R .y� a 4.:, a �s w V 4 ?`s4.- .}µiWT' Y .L 1 zF iv�'. "'
Ad•Mona wor to •e pe ormec un•er t is permit-c ec_a that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator . _Roof Pitch------
_ _
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ C7 b 0. e-0 . Utilities: _Sewer _Septic Building Height:
tu 'j V 3•s°'. �§�a. � .,r,.4V,>t .,ate r t msµ. :4w .. .. 4 ..rig#`�� f, re, okq $ .�0- ,#,--
Name Z o c.S o (f liteco, Name:Tian.K: G a 0 I --27.-
Address: Got( d se-Q- e 1 ci ':. 3- Company: r Lo✓l. 6‘ d AJi c i a .z,/2i'np. .
City: tor- i eibc State: Address: fV g: 1 SL 13:0/4 c 01. Avg.
Zip 'q Code: 3 . Fax: City:1or)- S} tot.,' State:l=L_
Phone No. -- -- bag:- gifoZ Zip Code: 3Lii 5 Fax:
E-Mail: Phone No 1-1)-- 57/- 5-7-5
Fill in fee simple Title Holder on next page(if different E-Mail L's-gn k:Z et t 1 co'ot /(IAA/
from the Owner listed above) State or County License C I� C f)é /a6
ctI
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i��0-7 3 s ' '1 "� asa r,i4�` g tr,. , p : < �'`' .;, `'`."c.• -';30ii! a.r7;1: te x`` `at
�c.L;a i`' (y:1 3:it°t, i'1'.q1 :1-fo '£'h is'F5iljzl;x d -) 1'
' F `" it_� 3#P- �?' ,a n w•.,, `='`:,r .s,—" c 8 ,,r
v:�.'.ry' .. } ?S__.u�...z. "ih.-..[ `�-3 «"K e..u�t.`.a�"u$LS _h,YSAY+S to �2��15.+�,',� � ' T-�...�.N.�3 �s&'1s�2c�.34s�3....s�94x�l�:"
it
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 your pro•erty.A Notice of Commencement must be recorded and pos :: o the jobsite
before the first inspect'. If you i end to obtain financing,consult ith lender or a . or ey/ore
corn : cing work or '.rdin •''r Notice of Commencement.
dtv,' ,,,/et/ 44/- . .//•iir/
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contract° icense Ho(er
STATE OF COUNTY OF FLORIDA S'c U x C'. •
COUNTY OF STATE OF FLORIDA S\-- . L-v.0 e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 0.9 day of IV DV , ,20 lg by this 9-°1 day of IQ O\/ - ,20J. by
(ran h GaAI>1 k P ' cCJn1C___ 6-akTh
_— ----(Name_of=perso[vacknawledgingi-__— _ —__-__________(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 :I:,Produced Identification
Type of Identificati Type of Identification "' z
���"'' ELLEN VAUGHN
er a���Produced 1` ._QL Produced _ ) l— s = .f Florida-Notaryublic ;�R 11 " `*.^A*= Commisn #GG270079o� gym% [CENVAUGHN �sA
'_ �o'sState of Flon a- otary Public
=* ''%'� *= d Commission No. '';',40ct�oZ.`' MY lesion Expires
Commission No. --4,;.,,r,,,,„_ CommissiG'270079 October 22, 2022
,,,'p,I: .My Commission Expires - -
- - October.22, 2022 •-
REVIEWS FRONT"', ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE ' MANGROVE"
COUNTER REVIEW REVIEW REVIEW REVIEW • REVIEW REVIEW
DATE
RECEIVED _
DATE -
COMPLETED
Iev.7/2014