HomeMy WebLinkAboutBUILDING PERMIT APPLICATION11
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date �' ] • (1\ S6ANjIL%t Number: J!�A'm&
Op DIV RECEIVED
Building Permit Application APR p 3 701g
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: iBuilding -J
PROPOSED IMPROVEMENT LOCATION:
Address: L -M N- oA`_S bkvd
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
/0 Ba
Commercial _
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Side: �<® Left Side:
Permitting Department
St. Lucie County
Residential
U� ��-
U VL J rce L L4L/ ;
Lot No. 2-0 LLL4
Block No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: - {
Additional work to Lie e ormed under this permit - c ec a apply:
HVAC Gas Tank ❑Gas Piping _ Shutters W
/indows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: L1 G I S . Ft. of First Floor: <ga S
Cost of Construction: $ 36�r ope I Utilities: Sewer LJ Septic Building Height:
OWNER/LESSEE: ;`
CONTRACTOR:
Name /Lfr' %I%i 5• G}tL
Name: MCA L
Address: 'ZOLAL C2-k<V '6
Company: (% L-e u
1-V__B0YI Y1C.
City: �Y\se" &q cyN Stater
Address: 0 %-A o ct-avN C \ qt'
Zip Code: �L��IS"1 Fax: A
City: !CeL C
State: -
Phone No. M22-2.Z-5-L-ALA 1 • !
Zip Code: [cL
Fax: }A' '
E-Mail: (V\4C_�k (VAP�1- YL\ .CoYVC
Phone No. 77 _-ZZq-
qL j:3q
riij
Fill in fee simple Title Holder on next pagel( if different
E-Mail: M01 Iit
o{
from the Owner fisted above)
State or County License:
I
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. cv r'►'t
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW. INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable I
MORTGAGE COMPANY: Not Applicable
Name:�rade'1R
Address: Ln sU Ccc-nncA 4,,(e nuy1 •
_
Name:
Address:
City: S�uaf4 State: _(L_
City: State:
Zip: ?3A Phone "111 28-1- $7-68
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I
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 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 Associatio and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I dhereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building diodes and St. Lucie County Amendments.
The following building permit applications are exempt from
accessory structures, swimming pools, fences, walls, signs,
WARNING TO OWNER: Your failure to Record a No
improvements to your property. A Notice of Comi
before the first inspection. If you intend to obtain
commencing work or recording our Notice oA Co
going a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
: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 Own 'r
Signature of Contractor/License Holder
STATE OF FLORIDA� 1
COUNTY OF �1`'t JCL �- C�vL�
STATE OF FLORIDA
COUNTY OF S� LctC�
The forgoing instrument w s acknowledged before me
The forgoing instrqrnpnt wa acknowledged before me
Eby
this � day of 20 LL by
this 2-7-day of rCT- - . 20 1
A(a6k c-> .
pt(oCAC- 1 S
Name of person making statement I
Personally Known OC OR Produced Identification
Name of person making statement
Personally Known _ C OR Produced Identification
Type of Identification
Type of Identification
Produc d
ProducedIf
—
TERESAL
tt o tary Public -State df•�•�rrf,� �1Y COMMISSION # F
i atur otary Public -State oo a; : MY COMMISSION6�
z '� C� '� '�• EXPIRES May
Commission No. Z- °; eal I
5 0IIlY f XPIRES May 05.
LZom�niss n No.�y 22
t ::
. -'c'a FbHdallotaySery
,(Sear
con•. �'�C': s msidallotayservice c
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17