HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CN2A N4 Permit Number:
IF
u ,III CEIVED
�
.M Building Permit Applica ion SEP 0 018
Planni g and Development Services ST. Lucie County, Permittiil4
NEB
euildin and Code Regulation Division
by
23001rginia Avenue, Fort Pierce FL 34982 . /
Phoril (772) 462-1553 Fax: (772) 462-1578 Commercial A Udb(W 4idential
ICI
PERMIT APPLICATION FOR:
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Legal D
scription: W (zr L�kP •�i 4�'k S� r7 ,L_\<_ _X_ I
Properlly
Tax ID #: DC1' ; l - -7 I OO 3� - O00--- Lot No. 1
Site Plan
Name: Block No. Z
Projec
IName:
Setbacks
Front . Back: Right Side: Left Side:
IN
D ws# 1
MW
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II
iti
Aechanical
na wor to be pertormed under this permit - check all that apply:
Gas Tank Gas Piping _ Shutters _ Windows/Doors
�I
_ _
r
lectric Plumbing _ Sprinklers _ Generator �oof 12-. Pitch
_
Total S
ofConstruction _/ Sq. Ft. of First Floor:
Cost`'ofijlConstructio'n
1 f ,i
'$ '`�'� %tom°. + Utilities: _ Sewer _ Septic Building Height: —�
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4.
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Name
f::1, o L.LC
Name �DI�t►[ ;t7�"�''�1�-i�1�
SL�13
sI
Address:
City:
C"n: State: =
Addre/s�s: y(�v SL.J� .644A., {c�
City: S%_ U.vCce. Stater
Zip Code:
33oa'� Fax:
Phoniei
No. '-?S�-k-L--2''� --di'3�-2J-4
Zip Code: s �15:3 Fax:
o` C �c�r c���_Cfl�
E-Madll:
Phone No So' G/c -
simple Title Holder on next page ( if different
Fill inl,fee
E-Mail
from
he Owner listed above)
llof
State or County License C6C K12 9,936
If value
construction is 2500 or more, a RECORDED Notice of Commencement is required.
aa�pggryyyy
ii yy ff .
MORTGAGE COMPANY: - N6t-Applica6lle
DESIGNER/ENGINEER: _Not Applicable .
Name:
Name:
Address:
Address:
City: State:
City: State: II�
Zip: Phone
Zip: Phone: Ili
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Name::':,; ,,a n•..`,.
_Not•Applicable
Name:
Address: `,'`;
Address:
City: J
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
is in
which 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 followin uildin permit applications are exempt from undergoing a full concurrency review: room additions,
accessory st' ctures, wimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use II
WARNIN TOO NER: Your failure to Record a Notice of Commencement may result in your paying twice for:
improve ents -y ur property. A Notice of Commencement must be recorded and posted on the jobsit'e
before t e firs ins ection. If you intend to obtain financing, consult with lender or an attorney before
c e cin o or recordingour Notice of Commencement..
Signature of Contractor/License Holder
S nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO D
�,
STATE OF FLORIDA
COUNTY OFF
COUNTY OF
The fo�rgF9-iing instr ent as acknowledged before me
this ay of 20� by
The forgoing instrument as a knowledged before me
his �p day of 3 20 1 by
h
C��r� 5�p -ea' ��-12,V�50Y1
�. "44�7 pt
etc
Name of person making statement.
Name of person making statement..
j
/
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
I
Type of Identification
Produced t Ociv X5 �,1'Gei't5 �—
Type of Identification av p
Produced- "+; o�P per, OrrettPrendergas�
Public -State of Fonda
Commission #FF 993263
Expires 05/17/2020!
III
(Signature of Notary Public- State of Flori'
of Notary Public- State of Florida )
Ptiosignature
Commission No STATE
k—PT1a5-i1'
?Cam
mission No. 2(�3 (Seal) `
MO FF
19
REVIEWS
FRONT
ZONING ,- .
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
N .
- .•, .
COMPLETED- .
ev. 8/2/17