HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE i r.0 FOR APPLICATION TO BE ACCEPTED
Date: oc7• % 7 Permit Number: l '7190 . b 5�
-- -- - Building Permit ApplicationFEB 2 7 2017
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 V
PERMIT APPLICATION FOR: paC k UJ'q1AJLJ„ ,
PRQP.®SED INPR®UEM�ENT LOCATION; I
Address: ID ! 1,91— MA/z nR
Legal Description:
Property Tax ID
Site Plan Name:
Project Name: _
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas7ank' _ Gas Piping iShutters
_Electric _,Plumbing _Sprinklers " Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor.:
Cost of Construction: $ a) Qj%. 6,9 Utilities: —Sewer _Septic
Lot No. NO
Block No.
Windows/Doors
_ Roof
k
Building Height:
OW�I�)'ET/LE-SSEE:
C®NTRACTOR:
Name
Name:
Address: d vIle
Compa B L d
City: � % State:
Zip Code: ,k33AJ3? Fax:
Phone No.
City: %DES L _Stater (�
Zip Code: _��� 9� i Fax: 7xi, deZ� d
Phone No f e,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail u6
State or County License d
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: jZ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: %/ Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Address:
Zip: Phone:
Applicable
DWNFR/ CONTRACTOR AFFIDVIT: ADDlication 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
rnmmnnrinn uLnrL- nr rurnrrlinv vnur Nntirp of Cnmmpnrpment.
Signature of O er/ Lessee/Contracto gent fo
o.) l4%
Signature Contractor/License Hol r
6
STATE OF FLORID—i4a:;5
STATE OF FLORID
COUNTY OF
m
COUNTY OF
d
The (a)iojng instru nt as acknowledged before ,
�� 2017 by
The forgoing instru ny�§ t y�a� s acknowledged before
thi day of f h 20ZZ by
�� a
this�lday of
mN
9 z c
� ppm
9 �2C
Q
h. STD
SF.
E.mT�
(Nape of person acknowledging)
1.8ti
a of person acknowledging)
a
a
(Signature otary Pub - State of Flbtida V
(Signat� Public -State of Florida
Personally Known V OR Produced Identification
Personally Know OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
R VIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED _
I
DATE
COMPLETED•
Rev.7/ZD14
All APPLICABLE INFO MUST BE COivir�'ETED FOR APPLICATION TO BE ACCEPT.. Gt_' I].�I
Date: Permit Number: ( IS 2 Q 15 `i j
MAR 2 2 2019
Building Permit Applicati n
ST. Lucie County, Permitting
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
PERMITTYPE:
PROPOSED INPROVEM ENT LOCATION:
Address: tO 1 CL KAa DA V
Property Tax ID #: Lot No.4,0_
Site Plan Name: LF'511 — II O roo S i no .— S�- Block No.
Project Name:
f DFTAILED DESCRIPTION OF WORK'.
CONSTRUCTION INFQRMATION:
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: Sq. Ft. of First Floor:
Cost of Construction: $ a'((Do Utilities: —Sewer _Septic Building Height:
OWN Rjt ESSEE: `° ,per
= _.
.a
'CONT'RACFOR
, rr a°• v f �
Name
Name:
Address:— Lw 57 RAY
V1exJ
JCL
Company:
City: &iL i /,.A V 9G-QT�R
Zip Code: Fax:
Phone No.
1 e16 '�-
State: FL
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: W--(20 �-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONST�IIC _ 'iIEN,LAW
INFORMATION
P 8 `' u
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 orand 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.
Ih 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 vour Notice of Commencement. -
CK
tAeA&,-2
Signature of wner/ Les ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE O FLORIDA
STATE OF FLORIDA
COUNTY OF
iLJGlF—
COUNTYOF
The forgoing instrument w s acknowledge efore me
rn.arn�,,
The forgoing instrument was acknowledged before me
thi�dayof
20-by
this_ day of. 20by
t 1 e>zIfAry`\U I k 1
k19,21 ef,
Name of person tinaking statement. /
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identific 'on
Type of Identification
Produced
Produced
LT&"�
. ,,
(Sigriatilre of Notary Pu is
ignature of Notary Public- State of Florida )"
Commission No.
,mr;:I,, KAREN S. NIELSEN
Z? :st,!Wlorida-Notary Publi
•= # GG 207481mmI5510n
No. (Seal)
- mmission
My Commission Expires
REVIEWS
FRONT
, PLANS
VEGETATION
SEATURTLE-
MANGROVE
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev. 9/Lb/1.8