HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE cvMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A Permit Number: rb �1 la-aaa
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Building Permit Application DEC 01 2017
Planning and Development Services PLRn411-TiNG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce F134982 Q�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED ..,... IMPROVEMENT LOCATION:
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Legal Description: / 3G yU ;A? d i'-� Al ? 0 F S 13 Ac/f fs OF I-E 3 4�'-��
Z605-
Property Tax ID #: � ^ y�� (JUD f ? " Lot No.
Site Plan Name: d j/3 6 _I' W Block No.
ProjectName:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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164AIVI� 4,419 51rw ',,VG
CONSTRUCTION INFORMATION:
Additional wor to e nertormed under this permit -check a apply:
EIHVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
0 Electric 0 Plumbing OSprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
i
Cost of Construction: $ '?6 006 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A ST 4'413 6 S
Name: /�d/Iep-?
Address: 61 el f .PV,0,PAi✓ 4,1" 12 /_�
Company:
City: C /Q.RXYC C L State: fC
Address: 9Sz SC �N� d
Sl
Zip Code: Fax: %b
City: 1' (%
State: L L
Phone No: 72 ZN Z 63 " 190
Zip Code: 3 Y 9 9 7 Fax-7R - - ,Y6 ,Y 0
E-Mail:
Phone NOR 6 Z % 010
Fill in fee simple Title Holder on next page ( if different
E-Mail:.I-A `7 4rW1II% Al i~/&/
0/11
from the Owner listed above)
State or County License: ClrC 1231
2, -513
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: 0 KJ//�
Name: 11_191��'
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 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 vour Notice of Commencement.
Signature of Owner/ Lessee/Cont r or as gent for Owner Signature of Contractor/License Ho er
STATE OF FLORIDA
COUNTYOF 5-1r.
The forgoing instrnent was acknowledge4 before me
this _\_%day of Uk C_ 20.11 by
1p-t'+ �erSl�becq�
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Producedyc- �-
STATE OF FLO131QA
COUNTYOF
The forgoing instrument was acknowledged before me
this Va,-, day of 9R e . 20a by
C dbe r"t "-�r.0,�Ar .1Q, i
Name of person making statement
Personally Known OR Produced Identification
Type of Ident' cation
Produced Z- fl L
(Signature of Notary PLW[ic- State of Flor' (Signature of Not
�N�A�M�ARIEGNENS RYP DEANNAMARI GIVENS
Commission No. ,. ..;9' NlvcolN �N#GG022023 Commission I � � YCOMMISSI� #G 022023
tuber 16. 2020 : l: PIRES: De 2020
.~ = EXPIRES: Dec' ro:
Notary Public Underwriters ",;FOF o?•' Bonded Thru Notary Public Undomriters
Bondedihru
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW I REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17