HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: all �� �'� ���� Permit Number:
,- BY
• atLu le� county RECEIVED
Building,Permit Application FEB Q g 2098
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Pttinc
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 re--rOOF rne�4
:PROPOSED,,IMPROVE MENT�LOCATION �. ;,.
J ,.
Address: JJ3 I al Tht'SaiGI .r� i%i� �C I
Tl
Legal Description)u-uSAeiid Sand 5 (1. 0(o AC
�o rz t ` 99 99a 4) -
Property Tax ID #: 19 L1 3 Q) - Lot No.'� f"
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESnCRIPTION OF WORK ;,�; " �.
,r0� F H �M clown t , ��. �e-nl�t.c1 -io cJd+c, lnS{-�l1 12�sic}�
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CONSTRUCTION INFORMATION � "'
•`.J°ft r,.. ,.. s�
Additional work to (enej orme under this permit -check a apply:
E1HVAC L__I Gas Tank ❑Gas Piping In _ Shutters
11 Electric ❑ Plumbing Sprinklers FI Generator
Total Sq. Ft of Construction: 'Y3 5q-�'
Cost of Construction: $ 15, 1 r G
S Ft. of First Floor: _
Utilities'n Sewer El Septic
QWindows/Doors
Roof Roof pitch
Building Height: I
OWNER/LESSEE
CONTRACTOR
Name �,t le-?br4t4
Name: rec-j 4Rfy, SdYl
Address:'c15iq 7InouSgn4f P1r1 PS bP_
Company: '6-}— tl(C
91DL)-,'n
Address: lel' 3S-3
erdo IV -
City: -PD(-i- P;er-re, State:!
Zip Code: 3H e(g' ) Fax:
City ppr+ S;4- l.\-,- a, C
State:
Phone No. q rl 2 - 31-11- Cl 9 a
Zip Code: 3LGt 8N
Fax: '9 9') 70'l -735H
E-Mail:
Phone No. r!'%a - UH-
r-J I 3
Fill in fee simple Title Holder on next page ( if different
E-Mail: &- I u & f 'r 00 s=, nq @b�a1n Qz, G3►,^
from the Owner listed above)
State or County License: Ccr
13311C is
[I Vd1uc W1 Uunsiru"wn 15 -?covu or more, a KLLUKUtu notice or commencement is required.
SUPPLEMENTAL;CONSTRUCTI'ON
JEN}LAW,i 0 RMATION
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.
Signature of Own / Lessee/C ntra or as Agent for Owner
Signature f Contractor/License Holder
STATE OF FLORIDA -
� �-�G' i1
STATE OF FLORIDA L A
COUNTY OF
COUNTY OF L3+
The forgoing instrument was acknowledged before me
The fooing instrument was acknowledged before me
this X day of `�� . 20� by
this 1rgday of 20 IV by
"re 14,qm z,--1
)q-qry\_ K)
_
Name of pers n making statement
Name of pers n making stat ment
Personally Known t,/ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida )__ (
(Sig dr . .N�'6+�hi�Y�➢) r a )
CommissionN efi' ���� P OULX
16o517
'': ;`c MY COMMISSION FF 160517
Co eal)
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MY COMMISS 10
EXPIRES temWr % 2018
,,� , 2018�
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(407 398-0153 Fladallotary3 ivk .00m
(40.. 3.. 53
REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
`l`2
Rev. 8/2/17