HomeMy WebLinkAboutBUILDING PERMIT APPLICATION4
r
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� SCANNED Permit Number: 1�0 5�d65a
BY
St Lucie Couhfy RECEIVED
Building Permit Applicatic n MAY 01 201g
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: ;Roof ^ yn��p�`
Address: ''1 Z6`
Legal Description:
Property Tax ID #: 0--'S ',::�U
Site Plan Name: �>
Project Name: --c) CI VA
Setbacks Front Back:
Right Side: Left Side:
e VA WJ9—
Lot No. A3
Block No.
11 Electric ❑ Plumbing Sprinklers 1:1 Generator ® Roof E5__1 Roof pitch
Total Sq. Ft of Construction: _� to a- S Ft. of First Floor: ;J /'P
Cost of Construction: $ /// oo 0- 0 0 Utilities: _ Sewer Septic Building Height: aJ bQ
y x
r
a%N��t. SSA E �� � � �
a t
�� �� � ._
"Paw.5_ xa. •`:.. io., .0
,.,_ _-r<,,- as „dx .�, ',. k i s..i,.
Name 1_-
Name: I G.0 G1t�}s2d1 ��
Company �1yt3� �7�C�^[�C'S ii� (°
Address:' _'56�
Address: �iS l� ���1��-et1,n (�c�
City: �-�- _ t'i.e�C.L State: -T�'J.
Zip Code: 1H Fax:
City: LL) l State: %JJ.
Phone No. q Sq- 563 - 3�s a-�
Zip Code: 3q 9 r-P, Fax: 0 A4
E-Mail: %,
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail: \ G'i •L
State or County License: 10
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
UPP EMENTA[: CONSTRU TtUN l tEN IA�tY tNFORN1AT
..Ny .._
ON ° r ,,
. .
DESIGNER/ENGINEER: x 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 attorney before
commencing work or_Leccixding your Notice of Commencement.
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Sig ature of Contra or/License Holder
STATE OF FLOjD
COUNTY OF Ji'. L�'C�-C�
STATE OF FLORIDA
�� Z�� cft
COUNTY OF '
The for oing instrument was acknowledged before me
thisv�day of ! / , 20a by
The forgoing instrument was acknowledged fore me
this D 7 day of % 20 by
��.lilr�.. L��.� �Gir����,�.➢-¢�
%/r1i�., .f�iS ��i.��r,'i�.P�
Name of person making statement
Personally Known )e OR Produced Identification
Name of person making statement
Personally Known )a OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�i
(Signs re of Notary Public- State of Flo )
s,,axFu6� KENNY `'
Commission No. ?° "''-�' on#GG144499
*
:sr tea¢-ExpiresSeptember19,2021
9rFoaP�oP ,, SondedTlwBudgetNo�rySer&ar '
(ign re of Notary Public- State of4roricla )
SrRY a MARK KENNY
a° ;
Commission No. * Con#GG144499
c� Expires September 19, 2021
��FOFF�B=WTlru6*stNotwySenioe$
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17