HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:, . 3' �3,— I�j Permit Number: \c\ O TAI
Building Permit Application MSR
Planning and Development Services
Building and Code Regulation Division ST. Lucie County,Perm
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 LOCATIQ;N
Address:
3 I L( W � ' n 73c��1�, �3tg✓
Legal Description: K6V o )✓T e t2cp_ S A'a,_S Un t"L t 90 L0
Property Tax ID#: 1 C134 - off_ ®a ago— z Lot No. /
Site Plan Name: Block No. 3 0
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION Of'-WORK:
_Ask `
1�2 '' , - wfS d` Cl,
CONSTRUCTION INFORMATION
Additional work to be performed under this permit—check a appy:
HVAC Gas Tank ❑Gas:Piping _Shutters Q Windows/Doors
Electric 0 Plumbing OSprinklers ElGenerator a Roof Roof pitch
Total Sq.'Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2. Orad Utilities: Sewer OSeptic Building Height:
OWNER/.LESSEE 'CONTRACTOR
Narrie '- 1Gbz41J'•G it Z,le- Name: tike/
Address: Z'3I ��`L '��"< «z�v� K/� Company: Z'NnJo Via trs -, (pn�i t'�-s Vc
city:-;— State: Address!,,,.-._ .12 7
Zip Code: 3 r' llleJ Fax: City: State: Gc_
Phone No.(3`z/) Stele-/1O D(o 7 Zip Code: 3"JC17c7 Fax:
E-Mail: n?r_4�eJI,rC/G ia4 L/100 Cor), Phone No. 7-72— 5/51 3/v T
Fill in fee simple Title Holder on next page (if different E-Mail: J_, ,tWN0VA e"m-2from the the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
=SC1PptEMENTAL CQNS`FRUCTtON CIEIV 1.AW��N�Qt�M AT(C�11[ � T � "� �� � �� �;fl� fv
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 aiid 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 hereiy'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 w' lender or an attorney before
commencin ork or recording our Notice of Commencement:' '
Sig tu%OFLORIDA
essee Con r ctor as'Agent for Owner Sign of Contra for/Licen Holder
STATE STATE OF FLORIDA
COUNTY OF ST Gvel/It COUNTY OF S� Gvev`e
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 40f" 204 by this —day of20� by
Name of person making statement Name of person aking statement
Personally Known !% OR Produced Identification Personally Known_ 7OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota Pu ' -State of Florida) (Signature of Notaryublic7 tate of Florida)
�svv�• tiRYPoe• KRISTY SEXTON
Commission Noi Seal) KRISTYSEXrON C mmission No o (Seeal11
}i• r: Notafy Public-State of Floc d4
,` Notary Public-State of flori a ay
P< Commission#GG 208344
Commission k GG 208344 '?OWF cF My Comm.Expires Apr 17,2112,
„o►w,. My Comm.Expires Apr 17,2022
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Banded Ent
o g a iona otary ssn,
MUFMOWAMP
REVIEWS FRONT ZONING •S S NS VEGETATION SEA TURTLE .MANGROVE
COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17