HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONINFO APPLIC l(iNJO BE ACCEPTED
ALLAPPLICABIL ILISTBECI, il)!.Efi�b tAT
Dal SCANNO Permit Number:
40R
Building Permit Applicatilly(tyk, 'Pie
Planning and Development Services
Building and Code Regulation Division 06�?� ent
2300 Virginia Avenue, Fort Pierce FL 34982 V/1,000,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDk "It-K '
PR_ �M
Address: &01 "Penny Lan�'_
i
Legal Description: LaVe-wood Par lL Unrt�
(R(+19 lb)w&/) (o(z 31&
Property Tax ID #: 0m,
Site Plan Name:
Project Name: '�f-,Ph V0590�Z O-Chl
Setbacks Front Back: Right Side:
va 6q -z-
Left Side:
Lot No.
t3 /-7
Block No. '7 /
21.
'4
I�DETAILEl)DESCRIPTION/OF WORK ;441: <I
-7��,-44
I
lac 14 6 -taW 561a'c' 11c%:t
0? 3
711q
CONSTRUCTION , INFORMATION _'
;
Additional work to be nertormed under thjs permit — check all apply:
EIHVAC Gas Tank []Gas Piping In Shutters []Windows/Doors
Electric Plumbing []Sprinklers E]Generator L;tRoof Roof pitch
Total Sq. Ft of Construction: c-23 00 S Ft of First Floor:
Cn D
Cost of Construction: $ 17 q 9 Utilities: Sewer Septic Building Height:
OWNER/LESSEE -
�N A #W��'
'_Cb C t b
Name -zT05e_Ph � 6h2/5t/_ if
vicez 7-
Name:
Company:
Address:
Address: ft6j, nnw Zazx�
City: nje-j helz e-C' State: F�
Zip Code: Fax:
Phone No.
City: MC&O'-fic
Zip Code: Fax:
Phone No.
State: eq-
Laf - 6 7
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail: do-ti ria, f I h _Ybof.
State or County License:
cc?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL COvNSTR{ ACTION LIEN LAV1/
INFORMATION
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 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 and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorneip before
commencing work or recording your Notice of Commencement. I
7ignature o r/ hesse --e -- — etor gent for Owner
Si natu ;P_fl9ontractcW/LiceiWeHoIW
STATE OF FLORIDA ���.-
STATE OF FLORID���
COUNTY OF �'J Y L2(
COUNTY OF
The fgrg oing instrum `as acknowledge fore me
this day of 20 by
The forgoing instrument was acknowledged before me
this day of j(_ 20& by
_JJ__
�,
lffi
—'a
1/0 �aw� � ��l�v�l
Name of per . aking statement
so
Name of persorywnaking statement
Personally Known OR Produced Identification
Personally Known l/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
46a�
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of4WWeRose
DONNA BECKER
Commission No. air ' c My00tgf1TN#FF172997
* EXPIRES: December 25, 2018STATd&-4:II�.ORIDA
,Senices 8
Commission No. NOTARY PUBLIC
Notary
�r9TF
Comm# FF939919
N. We`
OF F`o�\�Q Bonded ThruES: Budget
Expires 11130/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
o
DATE
COMPLETED
tev. 8/2/17
DESIGNER/ENGINEER:
Not Applicable
--
Address: '
City:
State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
Name:
Address:
City:
Zip: Phone: —
MORTGAGE COMPANY: _ Not Applicable
Name: .....
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 comme i ced prior to the issuance of a permit.
St. Lucie County makes no representation that isIgranting 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 Owner's 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 Relcord 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 Ito obtain financing, consult with lender or an attorn before
commencing work or recording our Notice of Commencement.
I
4
Sigrature of Owner/ Lessee/Contractor as Agent for Owner'Sign
atu' a of Contract /Lice a Hol
STATE OF FLORIDA
STATE OF FLORID��
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of , 20_ y
this lE day of AOR20& by
2
"a _
Name of person making statement I
Name of perso aking statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
J
� x t' dd 1�
(Signature of Notary Public- State of Florida )I
(Signature of Notary Public- State of&Ws Rose
I
NOTARY PUBLIC
Commission No: (Seal)
Commission No. STATE(&P��.ORIDA
wCmm# FF939919
Expires-11/3012019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
c
Rev. 8/2/17