HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONX.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1a - ';L,9 - Z-o I 1 SCANNED Permit Number:
St Lucie County 01
Building Permit Application DEC g �0��
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 Residential ✓�•°•
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S:�_ K I
I PROPOSED IMPROVEMENT LOCATION: 11,C
Address:
5
Property Tax ID #: 3,4r)q-510-02-31-00-ff Lot No. Ap
Site Plan Name: N L P D iDh A-3 Block No. /S
Project Name: R o S1 de ncL F r Ate'l7cA d• KetA 4.en 1 �/ a n c.d
Setbacks Front Back: 15 Right Side: 7. 5, A0 Left Side: -75 I' 5
DETAILED DESCRIPTION OF WORK:
Fug,; j Qe 5•,dchc-e_
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit — check all apply:
3HVAC 13 Gas Tank ❑Gas Piping _ Shutters windows/Doors
Electric Plumbing I�S nklers 11 Generator B Roof 4l Roof pitch
Total Sq. Ft of Construction: a- �i . Ft. of First Floor: 1651• 01 (A C 1
Cost of Construction: $ 0,34 , oo O
sties: Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
od
Name erbet-,7tt
Name: D r
Address: 4- 7_ 11 Seth0 Se- 91 vci
City: For} Pi a fc e_ State: F
Company:
Address:
City: State:
Zip Code: 349 &a Fax:
Phone No.71A- J/ -4 8 7X-475- 7
Zip Code: Fax:
E-Mail: hey5uryeyor & At #5644A. n ei
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
17
--- 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
commencingwork or recordingour Notice of Commencement.
Rev. 8/2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEE
Not Applicable
MORTGAGE COMPANY:
•� Not Applicable
Name: K k�r1 nc�
Arc i tc�
Name:
Address: �.1 I 'Blvd
Address:
City: � pi{r�,.�.
State: F1
City:
State:
Zip:34°l� Phone7'/Z-4�S-3"i'4'�
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:�i,� ,�- �u�l►��en
Inc �r
Name:
Address: Stcnrisc
F,Iv�i
Address:
City: Fo,•} P� c r«- ,
F I
city:
Zip:
Zip:349£3� Phone: 77a- 4�5- 3"14�
ignat re Owne Lessee/Contracto asAge �f'or Owner
Signature of Contractor/License Holder
�
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �A U..1 Cl-C
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
by
this � day of (�L . 20>�]•• by
this day of . 20_
Name of person makin statement
Name of person making statement
Personally Known OR Produced Identification �
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced��C�c��
Produced
(Signature of o ary Public- Stat '�l r a
���) Jamie Greuli
(Signature of Notary Public- State of Florida )
h
.���
Commission No. U1 '•x� �al)COMMISSION iFF156
2�ommission No. (Seal)
EXPIRES: Sept. 3, 2
8
;'�°�`° NIWIN.AAgONM1IOTARY.0
!A
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
DATE
COMPLETED