HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED--,
Date: Permit Number: N' b
SCANEU
_ti By
Ke • C* wrip cot0v RECEIVE
Building Permit Application MQ� !
Planning and Development Services 0 98
Building and Code Regulation Division ST• LUC� ounty, Permlttin
2300 Virginia Avenue, Fort Pierce FL.34982 9
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ,
PERMIT APPLICATION FOR: 6qb 6 Yr� � v * uU f-e
PROPOSED IMPROVEMENT LOCATION:
Address: n I t 1
Legal Description: �� & 1 (a 1�Yll ��, ��L1°� a(� Ui' 1r
n
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Sidle: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
~1:y ���� .PCtre-L Salo l S'ea.r 1.o,�S �G�1 Po-re.,�
q1/fi2yo es ; e c> •. P�-I 1,✓ %`J�2 X % ��o'ia ,r I -�v r iv "1 u J'� S�J e,N✓� Q ^� e. bs v d`�
CONSTRUCTION INFORMATION:
Aaamonai worK to ne perrormea unaer tnis permit- cnec aii tnat apply:
HVAC _ Gas Tank _ Gas Piping _ Shutters , Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2-:K"
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address: (p 1 O R �L w (�
City: Fn f-+ V � 0 P(,\L State:r L
Name: 1M: p
y-,
Company: ,IM: .I^a_ t i9a.
Address: C-/® Z 'A ) w,
- -A (2-'We 0d) , Lc
10f
Zip Code: 14 Q 3 c� Fax:
City: ft- f9l,ee r c --e_
State:
Phone No. �a� —� C7 i - � � � �
Zip Code: 3 40
Fax: 47 %-- L/21-37 3y
E-Mail: i n Fo P, ) `Na v f-N, c_n m
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail: M AO(a 1 0-or►
4ry
from the Owner listed above)
State or County License:
AA 282 9-
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
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
Zip: Phone: I
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 prior to the issuance of a permit.
St. Lucie County makes no representation that is granting
which is in conflict with any applicable Home Owners Assi
structure. Please consult with your Home Owners Associa
rmit will authorize the permit holder to build the subject structure
ion rules, bylaws or and covenants that may restrict or prohibit such
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 Buildingl 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 Nol
improvements to your property. A Notice of Coml
before the first inspection. If you intend to obtain
commencing work or recording your Notice of Coi
:e of Commencement may result in your paying twice for
encement must be recorded and posted on the jobsite
nancing, consult with lender or an attorney before
mencement.
Signature of Owner/ Lessee/Contractor as Agent for Ownei
i
Signature of Contractor/License Holder
STATE OF FLOIDA
STATE OF FLORIDA ,
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge before me I
The forgoing instrument was acknowledg d before me
' Yhd
this QZ11S_ day of "4 , 20 by I
thigZk day of { , 20 by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced F t- �c"
Produced V L
(Signature of Notary Pu ic- State of Florida)
(Signature of Notary Wfir; RWt6 if=FJOrid .) Qz
DEANNA
?eta
Commission No. '�ov pa11ARIE GIVENS
Ril •;:p:"'v�i MARIE GIVENS
{�. MY COMPJJ c # GG 022023
Commission No. `�.. 1R�ii`�I�)j
EXPIRES. iiccerr(ber
7 MY COMMIS SION#+ GG 02202's
I)ecem ber 020 I
o; 16, 2020
so ,;5.
F F Bonded Thni Notary Public Underwriters
N derwrite
EXPIRES:
i Notary Public Underwriters
REVIEWS
FRO
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17