HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP'Lr i'ED FOR APPLICATION TO BE ACCEPTED
nntA• 11„ -) Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
RECEIVED
wele ®�'`� ' FEB f 6 2019
Building Permit Application permitting Department
St. Lucie County
Commercial Residential 1,--'
PRQPOSED`,1NPR01l MENT LOCATI{ N...
Address: & 1 Z-
Legal Description:
Property Tax ID #: 13 Q 0 (- W01--000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front 22. Back: % 5 Right Side: 1 E � Left Side: 1 '
DETAILED DESCRIFTlON°OF 1N{3RK: 1
_Mechanical _ Gas Tank _ Gas;Piping
I
_ Electric _ Plumbing
' _ Sprinklers
Total Sq. Ft of Construction: L��1
Cost of Construction: $ Lg00 • a
it.. i .cv-�='•ter �8
v
_ Shutters _ Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Building Height: 8
$OVI/NER%LESSEE =CONTRACTOR
da
Name: e)13r,
,,Address: %^7 Z ,., 1 '> ea,� V P
Company; IN , fA1 d el t
State:.;
Address: r
Fax:
City. c -e ce v State:
Phone No. -1'7Z - � f 9 -q z L 1
Zip Code: 3 LOY7 Fax: qr (-,553 2-
E-Mail:
Phone No `Z -1Z - 3110 -V3 Zt,
Fill in fee simple Title Holder on next page ( if different
E-Mail C P &e-ke r K't-w EL Ito arc
from the Owner listed above)
State or County License UoC, L1�014c( 5
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requireo.
SUaPPLENiENTAL CiNSTRUCTIO LIEN LAW INFRWU
MATI4N: q$�
DESIGNER/ENGINEER: _ No Applicable MORTGAGE COMPANY: _ Not Applicable
Name: 5�1;,,rog.5 IVI/-YIV.&,r/14 I�Vl415vt-11 ` °: ;Name:
Address: ,[?(,3'a ..Address:
v
City: C.lR. 6 J cd-e. State: F1 -. City: State:
Zip: �3 Imo Phone 7y7� S321 400-9 'Zip: ' Phone:
I
FEE SIMPLE TITLE4 HOLDER: _ Not Applicable BONDING COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: f Zip: Phone:
I
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 nced 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 Flo Iida 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 nonresidential 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
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agdnt
for Owner
Signature of Contractor/License Holder
STATE OF FLORLElAi
COUNTY OF 0-t-
STATE OF FLOBIDQ�-�.C�
101--(n COUNTY OF
The f rgggging instru nt was acknowledged before
this �tiay of 20 by
me
The for(g�oing instr;g-Me_ nt was acknowledged before me
this IO'13-day of Kzc-Z� 20_12 by
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary P lic- tate of Florida)
(Signature of Notary Public t to of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced QNSJ\-S•1 -
�e'•,
ota
Commission No. �G •` 1�e _. (
._ _ - '••';!FOFF�o�.•� My Comm.
Type of Identifica i n
Produced . FQXW—W`A5i
,•"tuira "•,,
Commission No. ��� :`; Not BETTY SLUTSKY
(+f fi°d�l�c — State of Florida
=". } r;
•''�s�P°'� Commission#GG16184 My Comm. 7
Expires Feb 9 2
ETTYSLUTSKY
Public — Stale of Florida
mi3sion # GG 161847
Expires Feb 9, 2022.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
_
ev. 7/2014