HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��yy
Date: Permit Number:��'`
RECEIVED
w MAY 2 7 707.0
mittin
Building Permit Application ger t. LucieCountyent
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 TYPE: 5 hed
PRCJ` 1ED t[�IIPRfl1/I;lVIENT LC�CATIC?N':.
Address: :]bS , and loi, 8VC , S66At, LL&ci e EL 3q 9U
Property Tax ID#: Lot No.
Site Plan Name: Block No:°Jn
Project Name:
OFII[ED; EAl
iIFTi+IN::C)tF WORK:.:
A 2�
coaTRuON
Additional work to be performed under this permit–check all that apply: ,�
Mechanical ^Gas Tank _Gas Piping —Shutters Windows/Doors
_Electric ^Plumbing ^Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: 501 Sq. Ft. of First Floor: On (
Cost of Construction: $ eZ t7 Q Utilities: „Sewer —Septic Building Height:
j:O1NNfR�LESEE,.:_. .: CQNTRACTC?.R:
Name JuAi 0�- I - A Name:
Address: -135 50LnC�•IO�w AV f - Company:
City: SouAt L-IAG C State: R. Address:
Zip Code: 240.O Fax: City: State:
Phone No. 4t4 ' D S5 I Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail-
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,2 RECORDED Notice of Commencement is required.
r
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: W 1�s alt" a Z}tent M oa'taaA C
Address: Address• 1.0 t 44 J �---
City: State: City: Ar-I AIA-t-a State: GA
Zip: Phone Zip:b'bl+ 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 Horne 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIM YOUR LENDER O AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
/Zl�a
Zi ature of Owner/ essee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �, COUNTY OF
OF FLORIDA
COUNTY OF St
The forgoing instrument w4s acknowledged before me The forgoing instrument was acknowledged before me
this 1`� day of �20by thisday of ,20_ by
XCA , tUntny
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification X!!9 Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced -VL T) Produced
dla,&L
ture of Notary Public- tat Notary Public-State of Florida)
,�,Vl' '\ ., Gabrielle
Paige
Commission No. h t �lotary Public-S (Seal)
w. :
Commission#
Xpil es 02" /2023
REVIEWS FRONT NTNG _ SUPERV SOR SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
1, the undersigned, am the owner of the following described property,
-73s, SCKd i cL A-VC Solr)t LJACI& ) 1;;L
(Parcellld#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will :not adversely affect the immediate
community.
"TLkn'jor CiC
Property Owner Name(Please rint
pert,y Owner 1gnature Date
STATE Of FLORIDA,COUNTY OF � >t Uwe,
ACKNOWLEDGED BEFORE ME THIS. NACkj� ?-0. 20
BY )�
-j"%0Y- C� Q\ WHO IS PERSONALLY KNOWN TO ME(DD)OR WHO HAS
PROMUCED & AS IDENTIFICATION.
M
tunelk 'k
SN��URE OF NOTARY PUBLICJ TYPE OR PRINT NOTARYPCA
COMMISSION NUMBER
(SEAL)
Qa SLCPDSD Reviscd 04/11/2011 Gabrielle Paige
Notary Public-State of Florida
Commission#GG 305093
Expires 02/24/2023