HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR
Date:
St
i
)PLICATION TO BE ACCEPTED. 'Q 2
Permit Number:
BANNED
BY
ide County
Bdilding Permit Application RECEIVED
Planning and Development Services MAR 12, 1018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �4 St' Lucie County
PERMIT APPLICATION FOR: j,),NC96La -rL)Mr ./p
PROPOSED INPROVEMENT.LoCA ibO A
Address: 117 QO&C-tm CA�'/4EYK/niA GT r nn.-r Pi _ r � 3Y,719,
Legal Description: I
OWNER/CESSE. g
... .
CONTRACTOR.
e
Name M6r-,l.0 -rul \ ry-\ I ri 8
Name: �. S. ill DOS G Lz`GT2/C, [.LC
Address: l ! % QVG(%N Cog 7yc'21NA C 1
Company: Glut% s, M OO/L.c
City: f'- O&T 10(EAC C. I State: FL
Address: 1 S E - 1419" V /L 991 vim/
NIP
Zip Code: �Ll(?y9 Fax: N
/Z
City: V S:A' Kish State: re_
Phone No. 7 O 1 " 5 ee - 5850
26/7-0
Zip Code: ✓ z 960 Fax: 7 %z - %qy` 2 y39
E-Mail: /VhA I
Phone No -7 7 Z - 6 q ` q6i y/
Fill in fee simple Title Holder on next plage ( if different
E-Mail oj! 666N COt% CAS 'T. N ! T
from the Owner listed above) I
o
State or County License EC / 3 OL Z Z
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
r14
i
SU'PPL,EMfNTAL CNSTRUCTlON L1EN t.AW tNFORMATtQV.
nsag• -d. `."'
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 themork 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 per 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 Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me,
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
(Name of person acknowledging)
(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
Type of Identification
Produced
Produced.
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 "
ev. 7/2014
0r, LUC.— c1
DESIGNER/ENGINEER:
App
Name:
Address:
City: State.
Zip: Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:_
e MORTGAGE COMPANY: 'bS Not Applicable
-Name:. _
_ Address:
City: State:
Zip:, Phone:
X--Not Applicable I 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 Ass patron 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, 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 frofn undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, sign , 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 obta n financing, consult with lender or an attorney before _
commencingwork or recordingour Notice of Commencement.
..d' •i�.0
J . %ne-�
Signature of wner/ Lessee/Contractor as Agent for O
ner
Signaf Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA�.
COUNTY OF
COUNTY OF cc����nn ���
The forgqing instrum93.twas acknowledged before me
The for o'ng instrum-ent-was acknowledged before me
thisay of Idm 20/1 by
thisay of—.,IaWt . . 20/' by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State f Florida)
(Signature of Notary Public- Sta& of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica '
Type of Identific ion
Produced •itSSK?"'''• SURGEON
Produced
1MUM! MSURGEON
;� MY COMMISSION # GG 13.6489
Commission No. :; P: EXPIRES;Ar(Y)3,2021
�jt
{,, s, i MY COMMISSION #�GZ; 89
Commission No. r•=
RES;Augu ,
''
' •'F.F`••'' Bonded Thru Notary Public Underwrite
�,,ok ft`p'', Bonded Thru Notary Public Underwrliere
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
'MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building 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
r
PERMIT APPLICATION FOR:
Address:
Legal Description:
I
i
Property Tax ID #: Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_rvic%.naniI-ai _ UclD 1 ai.in _ %Ja� rINn ig _ J1 FULLCI a _ V V n °uuwal vUWJ a
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: i Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
. P�iR/i�SSE:
00 CTQ g
Name (, __._ --- • --•--- �r•. �--;------ - i .
Name: __ . .. ..
•,, .,<;.
Address
Company rc2 : f `.,' .—
City: > �_` ` ° State:
Address��
_
ZipCode: Fax:
City:
Y•
State: —
Phone No.
Phone
Zip Code:
Fax:
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
IIIf value of construction is 2500;or more, a RECORDED Notice of Commencement is required.