HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONs
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , 2-0 I-1 Permit Number:
Building Permit Application DEC 1 1 201?
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: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMENT LOCATION
Address: yG.)q S, I nCL l'o-n Q_iVf_,r c`-r. r-_O r- - P1'erCsC
Legal Description: T A I be.r+ R _,;A1 e r S P ro IDf_.�y - 1 3U 3 S 40 Lot I
a-l"cf NJL�y So_r-� of Lam+ 2
PropertyTax ID #: (DQC),-) Lot No.
Site Plan Name: RCAN W10 ►"1 C( C h I C,L_GLn V1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
50) CA,(
r
CONSTRUCTION INFORMATION:
Additional work to e nertormed under tis permit -c ec all
app y:
�HVAC Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
0Electric 9 Plumbing OSprinklers Generator R Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (�) L{ 0 D
S Ft. of First Floor: _
Utilities:11Sewer Septic
Building Height:
OWNER/LESSEE,:',
CONTRACTOR.
Name ICI
Name: o v_>PXf Tr
O Yl
Address: L{ci Q_G (� . n a�I� I U
ompany: T_rW U In
pl
City: }--or+ Plc 1/ 0C. State: F-1-
Address: a 111
ar
Zip Code: en 3HWeAFax:
City: 17-0 r 4- I-D) er G
State:.
Phone No. _71 a-r31(D" ZOS 3
Zip Code: 3y G S � Fax:
E-Mail:
Phone No. '7 --) .;) - H Lo S - 0__3L.9
q
Fill in fee simple Title Holder on next page ( if different
E-Mail: T-r a h 1 O a) A U L - Q owvi
from the Owner listed above)
State or County License: C_I=C
y 58 ()LO
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Applicable
_Not
MORTGAGE COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City: State:
City State:
Zip: Phone
Zip: 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 Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and reviewyour 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/Contracto r� Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA \
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of . 20-0 by
this _ day of 20n by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signat re o o a Pub ic- S t of FI Ida
{S' ture of f' to Public- St of Flori )
•"'raiB .,,. KARLEY MARIE GIESY•VARNEY
Commis oL� Iir=State ofFlord�Se I)
,,••tpyiv"n�•o, KARLEY MARIE GIESYNARNEY
C o•AlctubEc�;�teefFlerida (Seal)
• ' - Commission s GG 099801
' ` ` • COINthissinn a GG 699801
: o = My Comm. Expires May 1, 2021
`:�My COMM, Expires May 1, 2021
ova• coded throuch Nalimal Netary r.
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REVIEWS
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ZONING
SUPERVISOR
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DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17