HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /n I
Date: SC- ANNgDD Permit Number:
VxE D
BY
Building Permit Application Permitting Department
st, I,V£ie county
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 V
PERMIT APPLICATION FOR: To -Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1 nn reek .,
Legal Description: ?fie Se//J�
r w �-nck ar`-t(c4 Zpf a'
PropertyTax ID#:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
��Uv- Q_0_�� .Ale- raa 0,1151 117fk11 _470M�i .
26 (, o` 5 r �7 rOlm 'e -Ae/ .0041 as a,,
CONSTRUCTION -INFORMATION: I/
Additional work to e e orme under this permit— check a apply:
HVAC F Gas Tank Gas Piping Shutters Q Windows/Doors
Electric :q PlJmbing HSprinklers Generator jaRoofC Roof pitch
Total Sq. Ft of Construction: -5t S . Ft. of First Floor:
�
Cost of Construction: $ 39, D , Utilities Sewer Septic Building Height: 1 °
OWNER/LESSEE:
CONTRACTOR:
Name 61cal/I IL `u- aa(, orfG
Name: SaVLQ r S O i&
Address: _7 l I t l . tr v e, Cat= f`
Company: R DQh , rS I /lJL
City: �Dr� ��� � � Stater C.
Addres3 � Zv ;4mi &X
J
Zip Code: �gC1-R11 Fax:
City: t° W NS I - State: L
Phone No.
Zip Code: '5LNT3 Fax: -772"8�c�'�a9 7
E-Mail:
Phone No. 1. / & 6 �L— b to 11 -4-1
Fill in fee simple Title Holder on next page (if different
E-Mail: S 01 i S V i PV>.(!Wtv" - Ai
from the Owner listed above)
State or County License: GCS l 3 n
If value of construction is $2500 or more, a RECORDED.Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 Owner/ Lessee/Contractor as Agent for Owner
' na ure of Contractor/License Holder
STATE OF FLORID . 2
11 �-�-
STATE OF FLORIDA[/
50 1
COUNTY OF I�IT
COUNTY OF I
The forgoing instrument was acknowledged efore me
this day of �li'nUOi� 20by
The forgoing instrument was acknowledged before me
this /5-day of �Q �rT_ 20 tr by
Fr-aklV AA- De-Rjo V_
Stu Sots
Name of person making statement
Name of pers n making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification 0. W C2vt,(sZ
Type of Identification
Produced
Produced
�,4-6
1�e
(Signature of Notary Public- St t of Florida)
(Signature of Notary Publ - tate of Florida )
/ ?oox p;4, MARIA MAJANO
Commission No. _ <I / !Se* COMMISSION i FF I$1
EXPIRES: Apol4, 201
io�°;:::"ec4, MARIA MAJANO
e�IPYC01�A1tSSI0N t FF 1
EXPIRES: April 4, 2
ommission No. i� �y 20L�i *Moo
Bonum Im Budget Notary Se
N�! Bonded Ttwu Budget Nd vy S
OF F`0�\Q�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
I
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17