HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:. 1,10 ri - f'�_�
Date:
&F605 fs 2
Building Permit Application
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 X
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Qet 5t��,u a Go�nty
Residential
PERMIT APPLICATION FOR: Modular office
PROPOSED IMPROVEMI,ENT LOCATION.
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Address: Sa Co Ole -CIA fJcr Aut • I onl 9 ,e.rce. FL 3q 9 S a
Legal Description: A�i4�
Prooertv Tax ID #: 3403-323-0002-000/2
Lot No.
Site Plan Name: The Crossings Church Block No.
Project Name: Saint James Christian Acedemy Modular Multi -purpose Bldg.
_sue m
CONSTRUCTION;.INFORMATION... `
HVAC Gas Tank `Gas Pi m Shut..:..
-Additionalworkto e nej orme under this permit- check a apply:
L_I ❑ p' g _ ters 11 Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: 11,152 S . Ft. of First Floor: 11,152
Cost of Construction: $ D(21.) Utilities: R Sewer 0 Septic Building Height: A
OWNER/LESSEE: ` "
CONTRACTOR:
NameCr F
Name: �oe.\ �zrcw
Address: 03 _ r•i
Company: co nt Snit k'%On
Address: nS50 - w, ►tJwc,. 29-
City: E64 �jf-rLe State:
Zip Code: 3q1,51 Fax:
City: F(94 �1�PLt Stater
Phone No.Zia- . b5- 5s $y)
Zip Code: -?w9 q5 Fax:
E-Mail:C_r c i , C.O
Phone No. `7ia- S71 164E
Fill in fee simp a Title Holder on next page (if different
E-Mail: a0e-1 9 in+ea C rP_+c o C..OrA
State or County License: C6C— 1 5a 336 -
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
NSUCTION LIEN LAORMA W INFTION
SUPPLEMENTAL COTR
. .< ....... ..
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:
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 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
rnmmcnrina WaLA, nr rarnrriina vniir IVntirp of C'nmmanramant
C>
LCo'ntralr/License
Signature of Owner/ Lessee/Contractor Agent for Owner
Signat of Holder
STATE OF FLORIDA\ l
COUNTY OF J'1' WC'Q-
STATE OF FLORIDA
COUNTY OF SN . \-.-.C��
The f r oing inst m nt was knowledged, before me
this (Q ac
ay of l)� 20\J& by
The forgoing instrument was acknowledged before me
this day of — \S 20_\I_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
of person making stateme t
ersonally Kno n OR Produced Identification
y entification
Produced
(Signature of Notary Public- State of Florid )
(Signature of Notary Public- State of Florida )
omrni igjl No. REBRCCA PERCY al)
3 °$, NptitF PtMW - Slats M F10'tld>t
• FF 912567
,••,.ii'AY PV
, W:40 = Notary Public - StatA
Commission No. � �; CHAIS7,�D22
;�v,' Commission # G�.y�''CoF FUM Comm. Expires
I/C OF f1. ���
NOW iW
SUPERVISOR
PLANS
...
VEGETATION
MANGROVE
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17