HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLf INFO MUST BE CAP tD FOR APPLICATION TO BE ACCEPTED
Date: IIIJ d� (� Permit Number:
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_ Building Permit Appli ation OCT ® 9 tots
Planning and Development Services
Building! and Code Regulation Division Pei mittisig DeJal"tman
2300 Vi tginia Avenue, Fort Pierce FL 34982aiCje
Phone:,(772) 462-1553 Fax: (772) 462-1578 Commercial -5 entiaa-
PERMITAPPLICATION FOR:few
,
i
PROPOSED
NPROUM!ENTO�
Address:
F42d `-'1 DePX QQ,LIL
Legal Del
cription: QayQt' 9a(�Y,—L.O�I��' QL-V- L LC* S
11 tJ) (ov- MANNED
BY
Property Tax ID #: �QQS �o��' 00b- 2) Lo
Site Plan Name: Block No.
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Project Name: * �t,o f C'UA-
Setbacks Front Back: 151 Right Side: Left Side:
DE Al E,DI DEMS: CRi)PT10N OF 1tiORK:
b\n -Sn C V u-lAA� s�i A P
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C01-NSTR=IJC�TION I;NFORMA I.ON
itiona work to be prmed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ EIlectric _ Plumbing _ Sprinklers _ Generator �oof Pitch
Total Sq. Ft of Construction: l�� Sq. Ft. of First Floor:
Cost oflConstruction: $ �� Utilities: —Sewer' _Septic.. Building Height:
I
OV1tNER LESSEE:
CQNI RACTOR:
Name C YUAI, � ng 1n-c-p 1
Name:
Address: '-J(,pC-) !A V P>eW P0-0—
Company:
Address:
City: foc-A: P1 ey-CSL. State:
Zip Code:Fax:
City: State:
Phone No. p%o _ LADS- 26- 0
Zip Code: Fax:
E-Ma,il: CN -- 1YQ Cyn ®Q01+C-Orn
Phone No
Fill in' fee simple Title Holder on next page ( if different
E-Mail
State or County License
from lthe Owner listed above)
I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
. �.� �i�i'A► �C�N�T �_ U" �
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f�1�URI�A
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MORTGAGE COMPANY: _ Not Applicable
Name: �T C CitI�C
Address:
City: State:
Zip: Phone:
DESIGNER/ENGINEER: _ Not Applicable
Name: Cwk &1 n .kA 0)6
Addre,WFO boy JS'C�a4l
City: QN c State:
Zip: "- Phone QN31- EZl 3 d-U�
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
commencin work or recording our Notice ncement
.,$ ,tg off. Owrr� / Lessee/Contractor as Agent for
hers
Signature of Contractor/License Holder
x- g
STATE OF FLORIDA
2 m9
STATE OF FLORIDA
COUNTY OF
�N
COUNTY OF .
"
The fo oing instr t was acknowledge gfore m
this day of 2010
ox
9 ;,T =
The forgoing instrument was. acknowledged before me
this day 20_ by
�V
of
Name of person making statement.
Name of person making statement.
✓
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Idb 1 Vic tion -- p.
Type of Identification
Produced vT' �..�i�
Produced
(Signature of NotauPublic- State of Florida")
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED "
Rev. 8/2/17