HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED yy /� r�
Permit Number: 1�0V'v
RECEIVED
Date:
SCANNED
BY
BUil'Mng`ale
it 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
MAY 01 7010
Permitting Department
St. Lucie County
Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: gore? ��Qy e lQC
Legal Description: tl'1Cl G(Ve; CA
a�3�o -►s l q _
Property Tax ID #:
Site Plan Name: 4C)L'-_`n�,
Project Name: }-10Lx_-o_rd
Setbacks Front Back: Right
es-e rve,
Left Side:
-Z)- igsLO-
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
i r� Cl 1 I 2Z ILIA O d Pr"Q -e�;P_rV I C-2-2r'1tr0n&4121
4v-an C--�r 4s_,3+Ck-N "D) I oad SV-'C_r I. ns
ry)O L.L-)-es ,
CONSTRUCTION INFORMATION: j
Additional work to be performedunder this permit - c ec all apply:
�HVAC L_I Gas Tank Gas Pi ing _ Shutters
Electric 0 Plumbing []Sprin lers Generator
Total Sq. Ft of Construction: S . Ft. of First Floor:
O
Cost of Construction: $ 1 1 r I Utilities: _ Sewer Septic
Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
n
ayvYu
Address: 9 01 CIQ1,
Company: E,/�,C9
I�
City: �r-� ' ' �� Sta e: ��
Zip Code: 3 Fa..
Phone No. i-1- 4WLO`
Address: 1 ` H &\JC'
City:
Zip Code: Fax:
Phone No.�1C�• —
0q5
E-Mail
Fill in fee simple Title Holder on next page ( if d'fferent
from the Owner listed above) '
E-Mail:(
(Ylq�
State or ounty License: 9D
a>DQ
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
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 giu intend to obtain financing, consult with lender or an attorney before
,corXg vour Notice of Commencement.
commencing work or re
Signature of w er/ essee/Contractor as Agent for Owner
Signature o Co ract License. Holder
STATE OF FL IDAC
(_-
STATE OF FLOR'IL ( �J
4
COUNTY OF `--"-- L�"�-_
COUNTY OF
Th �!9 rgaytgnstrum t a ckl owledge fore me
this`— of 20 y
I` 1 I CE �� �
Th"riinstru en was ack o 'led efore me
t'hof 20by
I ` CC ` _� 1 I CA
Name of son making statement
Personally Known OR Produced Identification
Type of Identification
Name of p making statement
Personally Known /'\J OR Produced Identification
Type of Identification
Produced —(
Produced
1
of Notary P lic- S of Florida)
(Sign re of Notary Pu lic- State of FloridaCission
Jignture
No. ti `��U11111U1���al)
o ission No. (Seal,)
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REVIEW
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MANGROVE
REVIEW
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RECEIVED
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Rev. 8/2/17