HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPL CABLE INFO MUST BE Com.-_-QED FOR APPLICATION TO BE ACCEPTED'
Date: ������ Permit Number: o� lys�0
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BY Rlecervea
1 �
S�. Lode crvn1,
Planning and Development Services
Buildin 'I and Code Regulation Division
2300 V g►nia Avenue, Fort Pierce FL 34982
Phones, (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
5T01B
Building Permit Application Pe Jll('"2
rm,ttng )
St• Lucie county
Commercial Residential
�PROPOSEQYI[UPROWEI1JIfNT LOCATIQ.N �3�'�,=�•i,. . sx, �.i�, �ar � _� � ���"` ��Y,�3 .E�: -
Addres 1 .16-M,5 t,`rf� Q`�'e 'J `Q'w�'-fi'TJ b<e09..64 fL 3ggo
Legal D Ilscription: 4T3.0 �D 6011 OIrl A- �T 11cile' _e CC?- E?C3' i f�
Propel,,Tax ID #: —�� (' _0 _� Lot No.�
Site PI Name: Block No.
ProjZjName: l ��''� l�/�/U/Z%��of� ��}d�✓
Setba
r
1ks Front Back: 5A Right Side: Left Side: _
ii i
DESCRIPT[0�1"Q WORK r $ � �� §
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e.>* �' xt e2l i5 Ea �A. fY .f;,•hTI..
r 4t�x nm i,r ..,e �..a .x" :.' � a•x a., m�i wzi .Tz x
V+.-i, x R'. �.&�'e:.. 'i� wlrf .� a�i� 31{w �e�'-&x \.•. 4,it�. .ki
Addit
p al work to be pertormed under this permit - check all that apply:
�lectriic
....Iw _1 vu., luln. ___1.It...6__ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Iq. Ft of Construction: 7
Cost ql Construction: $r%7C
'Sq. Ft. of First Floor: _
Utilities: _Sewer Septic
Building Height:
C?ItcNR/[:ESSEE= ,4 ,,ka,h r
2-
CONTRACTOR: ,,f
Nade
��, pc�V� 5—Vlil/
Name: A CA cS(2eDJT
ess:� n7�s a((NoQilZ 11-6T 3,0
Add
Company: Z1`f-Q_
l en.SPrt� l��P�} State:
City
Address: J 1)� &W-b
Zip
Code:Fax:
"City: Stater
Phol
a No.233gZ--v TZ3
Zip Code: 3 Fax:
E-
Phone No —�%6�
Fill
I:il:
fee simple Title Holder on next page ( if different •
E-Mail �i d!9 i C�1�/4�Aj l9a� Cd�
fro
in
the Owner listed above)
State or County License CC Q_
I�
S�5�'r
•
If vale of construction is 2500 or more, a RECORDED Notice of Commencement is required.
«'�t��{i�._a,+»ro'j��a°!".i�`
((.,���i''IRL
DESIGNER/ENGINEER:
of Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:-,'''
Address:
City:
State:
City:
Stater,
Zip: - Phone
Zip:. Phone:
1
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 he 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 foF'!
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsi'te
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice.of Commencement.
Signature of caner/ Lessee/Contractor as Agent for Owner
SignatureW Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA /f/J
COUNTY OF
COUNTY OF
The for mstr nt w acknowledge efore me
The gins m nt s acknowledge re me
this � "stay of 2010 / f
this day of 20 f y � 1�
�/'��- dG
(Name of pegs nowledging)
(Name of person ac nowledging )
r
I
l
(Signature of Not Public- State of Florida)
(Signature of Notary P blic- State of Yloricla )
Personally Known
Personally Know t� a Identification.
Type of Identification o KATHY K, GATES
Notary Public. State of Florida
Type of Identific tio, a KATHY K. GATES
�� ��'
Produced ��
o is§lon# GO 104018
produced to of.Florida
0orflfril elofl� Ci0 104018
Commission No. Nly carrt Px ' es July 17 2021
Commission No My cOrmm. tax IroS ®dl 021
Q )
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
R
Rev. 7/2014