HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 j Commercial
PERMIT APPLICATION FOR:
PROPOSED.INPROVEMENT LOCATION ,
Legal Description:
FOR APPLICATION TO BE ACCEPTED -
Permit Number: 1J COG
Building Permit Application
C.7 t-�
OAY\ vJ
Residential
.rooeIty Tray ID #• 3q f Q .5-30 r ®/ 9�2 - 00(0 5 Lot No.
Site Plan Name: izI C1et' i�Api< On iT- Block No. 3 9
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIPTION'OF 1NC4RK
e N'IR dRMr49ED 7>oc)4 �(G` Xa4 Gmd fzamp, C1C low curd iA Svbrner
did"Sumhl +IC6 - fl'nmsed --b place ct /yt-w [D) ling5 a,.uY)dv. �-x►sr-'
eir-�L[ ! 7I CY L tSTt ✓iL-1 ri �•
,"CONSTRUCTION INFORMATION ;
Additional work to be pertormed under this permit- ch-e-ER all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost o Construction: _Tc] c5 ..(0 as(z,
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height:
OIA%NER%LESS.f E"
CONTRACTOR:
ame Ke fl-r C � �g,
Name:1e
Address: 1 �4 K) r NAgI�N IGt AUe
Company:
City: 6 i"Y ST Guc I _ State:
Address: CAM')CAM'194b C Ir,
Zip Code: gFgP3 Fax: lLv G
City: _0jd'T S I-, Lucie- State: 1'
Phone No. -772 2�g -4a 6'
Zip Code: 3 ` 1Y SZ Fax:
E-Mail:*A
Phone No S/IO - 26 9 - 0 23 h
iJl in fee simple Title Holder on next page ( if different
E-Mail I G{G1.:f A• 4 2 G tloti► - Co
from the Owner listed above)
State or County License 0'7
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
Citv:
Zip: Phone_
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: one:_
Not Applicable
_ Not 'Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip.. Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRALTO AFFIDVIT: Application is hereby made to obtain a permit to do the work and inst ation as indicated.
I certify that no work or insta ation has commenced prior to the issuance of a permit.
St. Lucie County makes no repr entation that is granting a permit will authorize the permit holder to bui the subject structure
which is in conflict with any appl able Home Owners 'Association rules, bylaws or and covenants that y restrict or prohibit such
structure. Please consult with yo Home Owners Association and review your deed for any restrictio which may apply.
Inconsideration of the granting of is requested permit, I do hereby agree that I will, in all respe s, perform the work•
in accordance with the approved pla ,the Florida Building Codes and St. Lucie County Amend ents.
The following building permit applicati s are exempt from undergoing a full concurrency r iew: room additions,
accessory structures, swimming pools, fe ces, walls, signs, screen rooms and accessory es to another non-residential use
WARNING TO OWNER: Your failure t Record a Notice of Commencemen ay result in your paying twice for
improvements to your property. A No 'ce of Commencement must b recorded and posted on the jobsite
before the first inspection. If you inten to obtain financing, consu with lender or an attorney before
commencine work or recordiniz vour Not a of Commencement.
'\ �
Z
Signature of Owner/ Lessee/Contractor as Agent for O ner
gnature 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)
(Na a of person acknowledging )
(Signature of Notary Public- State o Florida)
(lignatu a of Notary Public- State of Floida )
Personally Known OR P oduced Identification
Personally own OR Produced Identification
Type of Identification
Type of Iden 'fication
Produced
Produced
Commission No. (Seal)
Commission, A (Seal)
REVIEWS
RONT
ZONING
SUPERVISOR
1
PLANS
VEGETATI
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
/-4
DATE
COMPLE D
1
`t
Kev. //LU14 - ~ '\
Awl
All APPLICA/BLE INFO MU3T.BE CO M . D FOR APPLICATION TO BE ACCEPTED
Date: �t Number:' ' 1
Permit I
`8GANNED
r RECEIVED
rIA rA11AW
Y - -- Building Permit Applicatio _APB,-o 3 20P.
18
Planningand-DevelopnieritServices t `.. - 5T_•LucieCounty,Permitting
Building and Code Regulation Division J
2300 Virgin aAvenue,-FortPierce FL-34982 -
Phone:-(772) 462-1553 - Fax: (772) 46Z 1578 Commercial, Residential :: r
- -
PERMIT APPLICATION FOR:... -
Address:
Legal Description: p ,
O :.` :. -
Property Tax ID #:
Lot No.
Site Plan Name: l�
Block,No.
Project Name:
s
Setbacks Front Sack: �y
RightSide.. L Side"
&' If • i ;
e:,- rOC X 0 Cc�
ocic rX ,' S
cP Qc U
Add
itiona work_tob_e_pe_rfo_rmec1 under this per it — c c a that apply:
-
_Mechanical _ Gas Tank .._ • _ _ Gas Piping _ Shutters - :. Windouus/Doors _.
;: -
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: I' q
S . Ft. f First Floor:
Cost of Construction• ! -
•$ Utilities: _Se er _Septic Building -Heighi::
Name. e 1i4 PSI? `.: Name: 6 G f
Address: % uCompany: U �% r
C
City: 5 �- State: r2. IAddress:. � --
Zip Code: Fax: /11/A City: State:�L
Phone�No. .2 „ Zip Code: -
Fax:
E-Mail: d-1A Phone No 6 - O )L b
Fill in fee , ple Title Holder on next page (-if-different E-Mail ? c' (c
from the Owner listed above) State o Coun icense O
If value of constructlon is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN
ERJENGINEEll: - - - NotA" 'ItcaliCe
Pp ' MORTGAGE COMPANY: Not Applicable
Name: t Name:
tity:
ddress: Address:' I State:
'Zip: Phone I State•
Zip: Phone:
FEE SIMPLE TITLE HOLDER: N �I t Applicable BONDING COMPANY: Not Applicable
Name: Name-
Address- I Address:
• city:
Zip: Phone: .. �I- -
_ Zip: -,Phone*.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby., ade to obtain a permit to do the work and installation as -indicated.
1 certify that no work or installation hascommenced-prior w the issuance,ef a peirmi ,
St. Lucie Coun�tyy makes no representation that K-granting a.permit will authorizethe permit holder to build the subject structure ` which is in wnflict with any applicable Home Owners Association rules,.bylaws ocand covenants -that may restrict or ptohibit such
structure. Pleaseconsult-mM-your-Home Owners'Associatlon and review your deed for any restrictions which may apply_.
to consideration of the granting of this requester permit, I do hereby agree that 1 will; in all respects; peiionn the work
in accordancewM the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The folbwing building permit applications are lexempt from undergoing a full concurrency review: room:additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms andac cessory uses to anotfier non-residential use- •
WARNING TO OWNER: -Your failureto 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"io obtain financing, consult witti-lender or an attorney before
commeinan -work or record ur Notice, of Commencement. .
Signal re of Owner/ /Contractor
' as Agen Sgnaur n
_STATE OF�FLOIUD STATE OF FLORpA
COUNTYOF ICOUFMOF u__r/ffLi��ce er
IifJ��1/i
,The forgoing -instrument was-admowledged befo l me The forgoing instru ent wras edcnowtedged before nre
this?�datr of . �� 20A by •- this4 day of 20 by
(Name of person adawwledging) (Name o rson acknowledge )
(Signatu of ry Pub of Florida) • I (S a of No Pu Gc--State of Florida )
4
Personal I(nown OR Produced Identfication Personally -Known- OR Produced identification. .
Type of Identifi n Type of Idtin
Produced a KkL4 OP12 Producedes L VkgWft Janie
Public, State of Florida
_ NOTMtY PUBU .
Commission No. a Commission# FF 167526
My oo&. 010ses Oct1i 9, 2018 Commission No. STATE OF FLOMON -
- I CaiartN FF921
REVIEWS . FRONT_ -ZONING SUPERVISOR' PLANS VEGETATION - SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW -REVIEW- REVIEW REVIEW.
DATE
RECEIVED
DATE
COMPLETED . L_-