HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ a2 s (o Permit Number:,
RECEIVED
•
SCANNED
• . FEB 16 2010
Buildigg,,1 Application
Permitting Department
Planning and Development Services St. Lucie County
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
Add ress: a 0 / Ir o De'. _7 /1e f / 'Ft, 17Y?
Legal Description: fieeeit e5& 6 6a%riv save. 2 l h� /a �'/G� /6 424, //
t'
Property Tax ID #: Lot No. t O
Site Plan Name: C Gar o l car (Kep i- Block No.
Project Name: C_- OL I Tsu-r'Kept n
Setbacks Front Back: 22--o Right Side: q.2r� Left Side:
DETAILED: DESCRIPTION,OF WORK
IP-1/' „ gKist'��� LA n, o 0 eA. 0
CONSTRUCTION 1NFORMATIO.N
Additional work to be nertormed under tis permit -c ec all apply: G
11HVAC0 Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator DRoof �� / ` Roof pitch
Total Sq. Ft of Construction: P2 a O S . Ft. of First Floor:
Cost of Construction: $ �. J Utilities:Sewer El Septic Building Height:
OWNER/LESSE,E .: ,..
CONTRACTOR.,..
,Name rn) (RLk rklo-PA
Name: 7-eee
Company:,81 relp2rS�r,,
ac- ,� Glcss on.►►s
Address:o✓nLye9v'e-
City: eg_%v►1 (;,rove_
State: 4Y
Address: t/a y3 5W r0A
Aw /tug
Zip Code: 3 /aa Fax:
City: a W ,/fv
State:
Phone No. Yl q- s. S
Zip Code: _:?,/95! O
Fax: 8`od%ar460.�
E-Mail:
Phone No. 7 �>a- aS:�3-Ald0
o
Fill in fee simple Title,Holder on next page (
if different
E-Mail: P/ a,1od r YaAoo
_ 4-o en
from the Owner listed above)
State or County License: V%
C_ fqZ, 03 0SF
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN -LAW INFORMATION:,
DESIGNER/ENGINEER: _
Not Applicable
MORT AGE COMPANY: Not Appli ble
Name: ��h a w s It i
_
Name:
Address: 7360 IV l4 S� 6�+,
Address:
City: Pla.�t�fia.�
State: /--c.
City: State:
Zip: .333 t 7 Phone 9S'/-7a7-
a10;L?
Zip: Phone:
FEE SIMPLE TITL OLDER: _
Not A e
BONDING COMPA Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: P e:
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 a jobsite
before the first inspection. If you intend to obtaimfinancing, consult with lender or an attorn b ore
commencing work or recording vour-Netiee.Qf Commencement. A y
Signature of Owner/ Lessee/Contractor as gent for Owner
Signature of Contractor/Licens older
STATE OF FLORIDA
N
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STATE OF FLORIDA
^o d
�N
COUNTY OF
COUNTY OF
The for oing instrume t was acknowledged befor
L1 "by
1 m a
The forgoing instrument was acknowledged before
this � day of l��ih 20Li'by
S2� g
MQ e
this day of
m
u�y
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Name of person making statement
Name of person making statement
Personally Known OR Produced Identifica
on
Personally Known OR Produced.ldentificatiq'�=:
Type of Identification
Type of Identification
Produced %1(
Produced
(Signature of N t ry Public- State of Florida)
(Signature of Not ry Pu 'c- State of Florida
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17