HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J `�2 ` Permit Number:
_ SGANR9E.L�
�► BY
P,iP rr�ltnt\ RECEIVED
o
Building Permit Application MAR 1210IR
Planning and Development Services
Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 1 Commercial Residential_
PERMIT APPLICATION FOR:
PR,C)R05ED INPROVEMEIT-LOCATION ..
Address: (Z fZ.0 A P f oR-T FBI E-- f L 51U-7
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: '�0 TT 0o fLz) �/ 1 Block No.
Project Name: t�0 T T 0-0 CLD C ��
Setbacks Front Back: RightlSide: Left Side:
DETAILED DESCRIPTION OF WORK:
� 5T.4!i- t3- -rI P A-, or 14 67-;9/v0— IF 6C/UIG2 4 -T 0R
C0NSTRUGTION INFORMATION„
Additional wore to be pertormed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:.$ / o, q9'5 Utilities: —Sewer _Septic Building Height:
01NNrER/LESSEE -CONTRACTOR:
Name 10AV110 PaT 1 ny R o f
Name: G, -5. &10b2t ELGC7-016�LGC 1
Address: 11 Z1 G (D P to G Q (2,'D A 0
Company: G U Y 5, m 001UL v
City: CGrt LCG State: Ir C
Address: Z 1 8 G. r1tZG D 9 VA I V 6
Zip Code: 34991 Fax: 1,16
City: \I. 6. rU 9 CIP G14- State: rL
Phone No. TM- 417
'Zip Code: 3 Z 96a • Fax: 777 - 79-1- zD9
E-Mail: /Y/r
Phone No 7-12 - S6q W 91
Fill in fee simple Title Holder on next page ( if different
E-Mail () s Gaw q CoIV\C- -5 JVe; f
from the Owner listed above)
State or County License 15C / 30D 61 ZZ-
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
Name:
Address:
City:
State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
Name:
Address:
City:
Zip: Phone:
I
,MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 andposted on the jobsite
before the first insnection. If you intend to obtain financing. consult with lender or an attornev before
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
. Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
I
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of . 20 by
II
this day of 20_ by
(Name of person acknowledging)
I
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally. Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification i
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING_
-SUPERVISOR'
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
•REVIEW
REVIEW
DATE
RECEIVED '.
DATE
I
COMPLETED'
ev.
tArr L VC-1— 6 v
k{ R
TRU LIE r�.aMA
IEJ
DESIGNER/ENGINEER: `i- Not App'iicable
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: I 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 such
prohibit
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
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for ;Owner
Signature of Con ractor/License Holder
STATE OF FLORIDA p
STATE
COUNTY OF o�ii►D(ncin1, ��
COUNTY OFORIDAn
The for ing instrumen was acknowledged before I e
The for ing instrume t was acknowledged before me
this ay of 20 by I
this ay of .�/GL+/l_ 2Q� by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- StateAf Florida)
(Signature of Notary Public- SWfe of Florida )
Personally Known OR Produc
Personally Known OR Produced Identification
Type of Identifica „y,�.WILLIAM$URGEON
Produced :i`"''•: N # GG 139489
Type of Identi '
<49Y Pf 9'',
Produced WILLIAM SURGEON
+o� EXPIRES August 28. 2021
S.j ;* MY COMMISSION F GG 136489
"•"�
Commission No. '''� a�' ThruNate glgtlbUndetwrltere
oQ= EXPIRES:August2
Commission N .•+rNoaryPublIc nde ters
o
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
All APPLICABLE INFO MUST BE COMPLETED FO APPLICATION TO BE ACCEPTED Im
Date: Permit Number:
ilding Permit Application
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Additional work to be pertormed - under
_Mechanical _ Gas Tank
—Electric _ Plumbing
Total Sq. Ft of Construction,
Cost of Construction: $
Right Side:
Left Side:
rmit — cneck an tnat-appiy:
Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor: _
_ Utilities: —Sewer —Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
r<
Name, . ��
-
Name
.;
Address4.i ti..
Company ,.
City *a_ r _ .,.,_, .._ ,.., .. .... , _ State: _
Address
Zip Code: Fax:
City: State:
Phone No.
Zip Code: Fax:
i
E-Mail:
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.