HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �cANNED Permit Number:l�a1
BY
5a,'= si Lucie County RECEIVED
Building Permit Application 3 0 2M
Panning and Development Services
Building and Code Regulation Division LAN
cie County, Permitting
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 lines t
'PROPOSED ;IMPROVEMENT LOCATION:
Address:-'-) (o 9 1 C--- L L V 1=7V I L_ i�::_ i 'P i C C: L_
Legal Description: AA Z 6 —._3 b CD o —O L;z_fD
E y O. T. a=- _ Y o F•7 o
PropertyTaxlD#: �.3a$-3ya_ tSCSo\-Oad�
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
1,6ETA'ILED'DESCRIPTION OF WORK:
Z' K � .� � 30 0 .�l � i C�, l CEO• rw�"° � . ,
I'X K 16o z
CONSTRUCTfON INFORMATION: ,
Add itiona I work to be nerformed under this permit- c eck all apply:
�IHVAC Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
Electric Plumbing Sprinklers E] Generator Roof 3 Z.- Roof pitch
Total Sq. Ft of Construclo : 3 o O S . Ft. of First Floor:
V
Cost of Construction: $ Utilities: USewer gSeptic Building Height:
OWNER/LESSEE:.
.
CONTRACTOR:.' " "
NameSTANL9Y W-
Name:
Addressjb 4 1 E 1-
Company:
City: - FT, P1 it i2G F,:
State: £Ir
Address:
Zip Code: 2 K 9 yS Fax:
City: State:
Phone No. 77z. ybSY391
77.2
rya ���•�'
Zip Code: Fax:
E-Mail:
P
, ft
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.
'SUPPLEMENTAL CONSTRUCTION L1'EAN LpW
INFORMATION x h'
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
commencine work or recordine vour Notice of Commencement.
AM."It 4 2-14
Signa ure of wrier/ Lessee/Contra or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St. Luctc Oo
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this a day of --fAIV . 20j by
this day of 2o_ by
S bra f� �R wve e f
Name ot 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
(Signature of Notarlj�}Stat�
GIVENS
(Signature of Notary Public- State of Florida )
— s ---`�-DO NA I
GG 022023
Commission No. -� MYCOMPdIS�
D �m ��g,2020
Commission No. (Seal) .
f\ Q �' onded ihru NotaN Public Undenrmters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REV)EW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
2_�g
RECEIVED
DATE
COMPLETED
Rev. 8/2/17