HomeMy WebLinkAboutappAll APPLICABLE INFO MUST BE LUMPLETED FOR APPLICATION TO BE ACCEPTED G n Q
Date: Permit Number: ,` c) 1 `� 0 �%� u
RECEIVED
Building Permit Application JUL 03 1019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential (/
PERMIT APPLICATION FOR: (3 LN LfLf{-%0 (Z
f PROPOSED INPROVEMENT LOCATION:
Address: 5609 Sp2000 TJ(�, F 0b r I`716"Ee ( L- 5y 1's 2
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: 51 A/ P I Block No.
Project Name: .5 1 NAIV 1
r
Setbacks Front N l - Back:_ /v/;q Right Side: N10 Left Side: 5
DETAILED DESCRIPTION OF WORK:
-D51V57/1(HT10A` Vf A 57-e.v/9-9y Gc�c2�tToR
CONSTRUCTION INFORMATION:
AbOitional work to be nertormpd un pr t m nPrnnit=-rhPr1e nil rat nnn
_Mechanical _
Gas Tank _ Gas Piping
_ Shutters
_ Windows/Doors
Electric _
Plumbing Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
A Sq.
Ft. of First Floor:
��F1
Cost of Construction:$
6995 Utilities:
_Sewer _Septic
i
Building Height:
OWNERZLESSEE:
CONTRACTOR:
Name
Name:
Address: S6D9 50V2VC,& Q/[
Company:
CcTfLrc-
City: r-ow11 ULC G State: rL
Zip Code: 3 9 9 6 Z Fax: A-�11
Phone No. 7 3 Z- �f 6 5 6 5 Y 5
Address:
Z19 E, *qtX o n- 0 iZ-
City:
Zip Code:
Phone No
111EAV 13r ,t c q State: F-L
3Z-46D N Fax: A
-7 71. - 3 to-0 - 7-Z1 S
E-Mail: '11ri
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail US 6G.-v L�) CD n cR 5T, IV -
State or County License cG 13 6 0 61 ZZ,
�•-_ �• ��••�•• ��• .� .1 n,VIC, a nc..vnucu niouce or commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ✓ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
✓ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY:
Name:
✓ Not Applicable
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
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORIDA�j
STATE OF FLORIDA
COUNTY OF `lG,�p�ga /Pj,��Z
pp
COUNTY OF o /LA4y e r
The forgqing instrume was acknowledged before me
this ay of 20ZZ
The for ing instru Tpatwas acknowledged before me
J by
this ay of '=Z)" . 20yffby
G
(Name of person acknowledging
z�[n.t Ql��.n
(Name of person acknowledging )
(/I//L� 'wM6 GtJ1G
(Signature of Notaryub/lic- State Florida)
(Signature of Notary Public- State Florida) t
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification r, yylL SURGEON
Produced '!f''=
Type of IdItific
BMMIBSIGN N (i0138l89
Produced•'+:`.':"••., WILLIAM SURGEON
�
EXPIRES: tt 28, 2021
'
.: MY COMMISSION 0 GC 130489
Commission No. UnduM+lln
Commissi?i �ej EXPIRES:Aupy6 21
IOM. N Nmry Publk_U_
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.