HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat ' �n • Permit Number: I U 0
SCANNED RECEIVED
BY
Buicfing Permit Applicatio
ST. Lucie County, Permitting
Plan ing and Development Services
Bull jng and Code Regulation Division
230 'I Virginia Avenue, Fort Pierce FL 34982
Ph ' e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROI70_SED IMPROVEIVIENTLOCATION
Addre1ls: ) C 3a'11 2nd 61do,� H4A -t h-e ►- s�-e�
IZ N U h pm sE y o i q n rye F odZ b ,
Legal escription: 9L-Y 11oLo• 010 FT MIL-, 7-9 NL y ) p 0 E?r - 'W ELy iy o .=T t77 L rb W RVV )4A 7'(_N 2
SLY DNS® 6t)W 39;2. DA FI- /L -7 y kvLY Z 9?. y3 'Fr /W L_.� 7W 1W_V 2 g 1. q 8 F7- MIL_
ME a
Prope
,y Tax ID #: 0LJ_-A9 Lot No.
Site PI
'n Name: C h a r Ies ). ),4 -rCR EP Block No.
Projectl'IlName:
dr.)-es /4AT«dCeZ. 6eberathy )-Jv04- UjO
Is Front Back: Right Side: Left Side:
Setbac
DETA
ILEb DESCRIPTION OF WORK:
e r �r L) V ,' d e d T -A "i s74 �
CON S +RUCTIO'N INFORMATION:
Add Ila wor to a er orme under this permit— check a app y: H ition
AC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
® El'ctric ❑ Plumbing ❑Sprinklers Generator 1:1 Roof Roof pitch
Total Sq. II t of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ , q D 1 v o Utilities: Sewer Septic Building Height:
OV1/NER/LESSEE
�.
CONTRACTOR:
Name 13r(kndo 1,-) (M-e gnn A. �'aicn
Name: aDa ' p • �'
Address: J'j 33 11 )-i-�..;zJ�Q�- .S+y o.-4
Company: e'S eA S W a e C n I ,
Address: 12O(P 6-e-h CtU2 m-e—
City: �-W )-' R eAm State: 1✓ L
City: 'Fa � Pica State: 'F L
Zip Codek 3q g 8 I Fax:
Phone Noll. in oZ 15 - 03 $,r
Zip Code: .3Li di$ 2 Fax:
E-Mail: 11 1
Phone No. 77A Li 1nS-2363 Jrna A I lo- tR30
E-Mail: , i oeS eAeCSF 1 u c4 e (@ QD 1 , co y3,
Fill in: dimple Title Holder on next page ( if different
from the wner listed above)
State or County License: EX, )30C)I2,03 f #a4507
If value of
pnstruction is $2500 or more, a RECORDED Notice of Commencement is required.
Sl1pPLEMENTALrCQNSTRUCTION
LIEN LAW INFORMATION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAG COMPANY: Not Applicable
Na
/\!j�
Name• rf'z%
Name:
AdTress:
Address:
Cit
e• State:
City: State:
zipf�
Phone
Zip: Phone:
FE5SIMPLE
TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
AV )A
Name: 10
Address
Address:
Cite:
City:
Phone:
Zip: Phone:
Zip#
OW ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cent fy that no work or installation has commenced prior to the issuance of a permit.
St. Lu lie 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 corjsideration 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
impr11vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befot'e the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comet, encing work or recording your Notice of Commencement.
,
Signs re o wner Lefssee/Contractor as Agent for Owner Signre'of ntractor/L tense Holder
S,Ti4 E OF FLORIDA {ATE OF FLORIDA
CO NTY OF ,, .1.�)j'!,(�. COUNTY OF Lu � q .
The r oing instr ment was acknowledge before me The forgoing instrul ent was acknowledgec�..,before me
this day of 204X by this day of 20 by
PersoName of person making statement / l Name of person making statement
Qnally Known OR Produced Identification ✓ Personally Known OR Produced Identification (/
Type'of Identification Type of Iden' tiff ion
Produced �� _ � L Produced �(_
(Sig' ture of N1
Commission No.
I
REU�IEWS
DAT81
RECOVED
DAT1111
COMPLETED
Rev. 8/V17
a Public- S
(Signature of Nota u I
. IELSEN
KLE-,Nyp
��PpvP��: taKe REN S. NIELSEN
of Flo(
:r�p
s�
t�71Notary Public
Commission No. _� ,_ otar Public
ommissi
# GG 207484
Expires
�,
n #G 207484` �.+lmMssion
�
2, 2022
ssion Expires
Juns 12, 2022
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
I
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW