HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI FTFn FnR APPLICATION TO BE
All APPLICABLE INFO MUST BE
,Date:
Planningjand Development Services
Building and Code Regulation Division
.2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number: 1 i C 1'Qix��
RECEIVED,
Building Permit Application
SEP 13 2010
SCANNED— •,,:.
p� Permitting Department
fay t. Lucie County
Commercial a &,ntial >
Address: 070S' 6d()YY /ND14.0 )Z1"v6n? 09,1y16(rVIe;r jplelQ rL 3 g15 Z
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Property Tax ID #: 3501 01 — S 0 Z. " DOD DB O 1 Lot No.
Site Plan ,Name: Block No.
Project Name: K Ld n) &y(1? 5 T C.OT7A Co E
e /
Setbacks 1 Front . Z t Back: 0v. &e Right Side: i 56 9 I Left Side:.211 3
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Additional work to be pertormed under this permit - check all that apply:
X Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
X Electric x Plumbing _ Sprinklers _ Generator _c Roof 5 1z Pitch
Total Sq. Ft of Construction: T �o Sq. Ft. of First Floor:
Cost of Construction: $ . Utilities: —Sewer x Septic Building Height: 114' " 3
®WNE /LES�SE:
CONT A (*3R
Name R0dij o S. 91-Vid BF2IG17rl(at /�. �G�!/hi
Name: �' 'O •tJN/l� S. KG G'/�
pl+AL
Cmn113 o/ L A Ff pAddress:.870S
SOfTAJ2Q
/
City: W0�'r P/ a 2 C t State: fG
Zip Code: 3" 62, Fax:
Phone No. "2- -4(01 -T 44 3
E-Mail: RQA)60 K Lsin3 4 @ GMA1L • CQA4
Acldressf:
City: State:
Zip Code: Fax:
Phone No
Fill in fee simple Title Holder on next page ( if different
from the, Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONST' U�TT * N LIE LA Ill,"
IQN:
DESIGNER/ENGINEER: _ Not Applicable
Name: I AUL IN SGC-4 IAf G
MORTGAGE COMPANY: _°GNot Applicable
Name:
Address: 19104- S• od. SI LT MO Rd St L*
Address:
.4
City: ftlltf S7. kLlCfg Sta e: _F I.-
City: State:
Zip: 34A 84- Phone
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: _ONot Applicable
_
Name: SAt" 11 A S OW AI&�2.
Name:
Address: ;;
City:
Address:
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•Countyy makes no representation that is granting,a permit will, authorise the permit, holder -to build the subject structure
which is inc Idt with any 6ppl!cable•Home Owners-Associatiofi 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 con`sideration',of the granting of this'requested permit; I do hereby agree that I will, in all Prespects, perfcrm the work
in accordance.with.the approved plans, the Florida Building Codes and St. Lucie Count y,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 T NE : Your f '1 re to Record a Notice of Commencement may result in your paying twice for
improve nts y prop . A Notice of Commencement must•be recorded and posted on the jobsite
before t e firs i p 'ctio , f ou intend to obtain financing,' consui:t witli lender or an attorney before
comm ncin r or r or ng yo,ur Notice of Commencement.
Silfdtpre,of f1wner Lessee/Contractor as Agent for Owner..
"Signature of Contractor/License- Holder.-, FFI
STATE.OF-FLOttID, ��
"COUNTY OF kAACA_P_1
STATE OF=FLORIDA,
COUNTY=OF
:Pr
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before mle
this day of 20_ by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR:Produced Identification
Personally Known OR Produced Identification
Type of Identifica,tio�
Type of Identification
Produced L,'i:
Olgnaturdeof
Produced t
Notary Public- St to of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ieuo!1 i�lOoP�� ,�.;�i�'��Y,
ommission No.
�uo!ss!wWoo sa
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REVIEWS
FRONT
$Ld,NG!HNH)\S'UPERV
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,.- ;CANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTED
PEVIEMt
�''RE I*
REVIEW
REVIEW
REVIEW..
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17