HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 . Fax: (772)462-1578
Permit Number: ,00/y3 P"'
(- wry , ,a ;- Fitt
Building Permit Application JUL 2:; 2020
Permitting L)epartment
St. Lucie 'aunty, FL
Commercial Residential --
PERMIT APPLICATION FOR: S 4r12 .
Address: me) // __'' Ap'w nn ) LL
Legal /DesMcrip-t�ion• /fie Aark--i%/I�TI %z A" �L� �7ZLB7' %l7
1�11IZS)f D12 3z7fr -1?n
Property Tax ID #: " U I7 - 60g3 -066 — 3 Lot No. _
Site Plan Name: S t / / Block No. /72
Project Name: 5120 � bG Xqk- OvS-e—
Setbacks Front Back: 16-1�/ Right Side: 10 / Left Side: 0'
_Mechanical —Gas Tank Gas Piping _Shutters VWindows/Doors
_✓Electric Plumbing _Sprinklers
Total Sq. Ft of Construction:' 1/20 (�`
Cost of Construction: $ Utilitii
_Generator /t".."'Roof Jr-%% Pitch
Sq. Ft. of First Floor:
f
s: _Sewer _Septic .,Building Height: /%tP
OW N ER%LESSEE:
CONTRACTOR:
Name ;ago "�-
Address: 2-7,Vo., Siw/
Company: 1/ s6M
r�i ; -
City: M• Civ - State:
Zip Code: 3 LW Fax:
Phone No, 7 2— - 03
Address:
e.
City: GrG
Zip Code:
phone No z!`i—
Fax:
y3 Z-
State:)i
�i)jdhz,co'n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or, County Vicense G/
D S�z3
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUFPLEMENTrAL CONSTRUC«TL•MRIMI LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 ppermit 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 robms'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 Ue,recbrded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorhey before
commencine work or recordine vour Notice of Commencement. •
I
XffzP
Signatu710
f Owner/ Le ee/Contractor as Agent for Owner
STATE OF, FLORIDA ;
COUNTY OF`_
The forgoing instr t was acknowledged before me
this ° day of 26X by
'�?en LA
Name ofpbrson making statement
e� axSignatur of Contractor/I,�' •ense Holder
STATE OF FLORIDA'
COUNTY OF
The forgoing instrnt was acknowledged before me
this °1day 204 by
Name oersoA making statement.
Personally Known . OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identific I _ Type of Identifica
Produced i = Produced`
(Signature of
1 r
(Signature
i/
"• :
AUDREYB-HU PH EY. ' '�
}!•"•••.``•. AUDREY-B.HUMPHREY.•
YP�°'
Commission N
___.. ••.:. hnyrnu
V�
MISSION 00817
CommissioD
MYCOMMISSIONRG
iai . •+= r(g1j
•
o `
EXPIRES: March 6, 2029 "
- •'-� L `.
`+; . P;; S: March 6, 2023
%Fodi:s":
FRONT
ZONING q SUPERVISOR
PLANS
;s4oa°,•• Bonded Thru Note Puhlk 1Indew7i1ers
VEGETATION SEATUfiTLE' MANGROVE
REVIEWS
COUNTER
REVIEW; .. REVIEW
REVIEW
REVIEW REVIEW REVIEW
tir A . , ... A. _.
/K.