HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPL M. FOR APPLICATION TO BE ACCEPTEq� w r�
-Date: •�'�' 1 Permit Number: I / I 0- 0 35�
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Building Permit Application
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL-34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: lVe W d e; z>&-NC
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Address: 131 b Lone- R; Z, '>' vfe q
Legal Description: Lone- i?tnZ Swbo6i elov► CIPB 51-2-4) i>-ts 4 aod S
CO3-?toA-c. -33J IOW SF) Cove 3?-73-235E5 3963- 2-12s")
Property Tax ID#: 3`fog-S09 -OOo000--? /4cc, (bto Lfoy Lot No. Lf
Site Plan Name: Block No.
Project Name:
Setbacks Front 51S` Back: 10` Right Side: y 0' Left Side:' IS
Haaiuonai worK to De perrormea unaer tnis permit - cnec
> Mechanical Gas Tank Gas Piping
_gElectric X. Plumbing X Sprinklers
XShutters
_ Generator
X Windows/Doors
_K Roof
Total Sq. Ft of Construction: (P 16 `f. Sq. Ft. of First Floor: 3101
Cost of Construction: $ 390 ono Utilities: _ Sewer Septic Building Height: 216 ' , ts"
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Name: 'In �oq
Address:Name
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PhoneNo.66/2
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Fill in fee simple Title Holder on next ..
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from the Owner listed ...
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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SUP.PLEMENTAL.CONSTRUCTION. LIEN LAWINFORIUTATIOW.
DESIGNER/ENGINEER: Not Applicable
Name: RowA-1v+ iiti.kt.t�sor,
Address: 8b(p
City: State:
Zip: 3,fi.so Phone Z1z— Zf ? —1359
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: I V,,St Cv 04414,
Address: qs i a) \�j F^eA e--ce 4 Hwy
City: Sti,� State: F- _.
Zip: -3 i't',`I Phone: r`i'IS-
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent k;,,�uur
Signatu of Contractor/License Holder
STATE OF FLORID > m�S,
STATE OF FLORIDA
a
COUNTY OF
COUNTY OF
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The for,going instrument was acknowledged befor re;o =
The fing instruent was acknowledged afille°this
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day of 2011 bythisday
of 20
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Name of perso aking statement N "'
Name of person king statement 4
.
Personally Known OR Produced Identificat .
Personally Known OR Produced ]dent
atioa
Type of Identification
Type of Identification
Produced
Produced
:�•
(Signature of N ry Public- State of Florida )
4-
(Signature of Not &Public- State of Florida
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
'REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17