HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMB rED FOR APPLICATION TO BE ACCEPTED
Date: )III /�g Permit Number: I l " 031�
SCANNED
Building Permit Application BY
Planning and Development Services St Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:,(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:IJ 3,20-01 okeeCAo4tee_
Legal Description:
Property Tax ID #: _oc3 oC 10- 6cns - Lot No.
Site PlanlName: Block No.
Project fame:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Rtaot,rl Sh;ngle_ fo y-v rro_fc.l,• V,s+h new Torch oown O a F'icii- ooF 61-PaS
5"v w. - Ea i 10 o A. FL. 1 g6g5. 3' R 3
-(&rch DOW,, rloA S �C- I(da'1_ IZ-- Sel /cIt'e"I %3ase S17P2 7ov�, Alpe) ed C4i° sae,+ �a 3
'fgrco Peps RlD f ye 3 " y1 'moo Zoo k'
CONSTRUCTION INFORMATION:
Additional work to ff
orme un er t is permit- c ec a app y:
[]HVAC Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof J /:�2_ Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
I
Cost of Construction: $ ���% C7U Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name kl bllrk P f e,,esa c-4ak ),
Name: 4a C
Address V 01rPPGkz"-C /Z(4
Company: 1411,e4aelfloe /f'ooXhl0
11V
City: `i)r/ %'ewe State:`/-
Address: •31r3 SGJ
Zip Code: &9 Z(9Y5 Fax:
City: J/fee h{e4c
State: )0011
Phone No.
Zip Code: YZ 96Z Fax:
E-Mail:�6�e-e/%� 77Z ® Olwzn, l,roo-i
Phone No. 772" %d�"vZ3'�'�
Fill in fee simple Title Holder on next page (if different
E-Mail: lo4eeAowlve'172_e
�.%. o�'►�
from the Owner listed above)
i
State or County License, , 29�/ 7
5-'7 0J
if value 01 construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCT LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:'
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
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
commencing woo6ir recording our Notice of Commencement.
gnature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA l
STATE OF FLORIDA ((��
COUNTY OF At Pit v
COUNTY OF
The forgQing instrume t was acknowledged before me
thist day of >J 20_ by
The forgoing instrum nt was acknowledged before me
thidC� day of ✓/ 20-C by
0�tl A,c.�e.
i
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produc
Produced
per/
(Signs ure of NotaryPub(!„
Commission No. �i
11A9
a e o4 Flori�a)jNt1 INGRAM
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Notary P blic - State of Florida
=. s �* ._ M ComXPIR.es Dec 20, 2018
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Bonded through Nation,! Plot^ry .az
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n e of Notary - -of Florida-
: o��r 0 ��� LA HAHNA INGRAM
z # o. NotaryPublic St of Florida
Commission No. _.f° �* = rrJe f
omm. Expl 6IN 20, 2010
N91 o-°=� Commission # FF i77249
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE ii
RECEIVED
DATE
n
COMPLETED
e
Rev. 8/2/,17