HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CJMPLb.-D FOR APPLICATION TO BE ACCEPrcD rv�
Permit Number: 1O0' I " 05 0 1
Date:
Planning and 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:
Address: �/ LQ
RFCFIV�O.
Building Permit Application 'er hngo'10�8
Lac(® c uney ®Qr
pis
Commercial
Residential X
Legal Description: CTot-A (9 t' SHF17 , i uL' etrrrn
Property Tax ID #: I � L ro 1--S ().-) 8SI (5 /,;(' Lot No.I_
Site Plan Name: S TJOA6fr SbtBO 7003 Pt-N,hcorA LA JC7 Block No. li-0
Project Name:
Setbacks Front_ Back:
N
CD
Right Side: ( 10 Left Side:
Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof 11 Pitch
Total Sq. Ft of Construction: F 0 0 Sq. Ft. of First Floor: 1 1'
G w
Cost of Construction: $ 0 Utilities: —Sewer _Septic Building Height: W t
Name kfja A R kLt o
Address: :?-o03 Puar�ark LrJ
City: 1p-T Pt MCE State: t��
Zip Code: 3`(1S1 Fax:
Phone No. -�;-70- 7� '- (6 Hro
E-Mail: -17 cAg-'( S' '6 70 @ A7r. NET
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
W03 &cun-rA- QJ
City: -T
P i M(. State: FL
Zip Code:
%`F15I Fax:
Phone No
5 70 - ((, b�
E-Mail
ICAA� s 570 AZf . Nr�
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: �)A v <3_ —nro ,
Name:
Address:_Z�c wirLiuA SaRr G e lob
Address:
City: CO NC> 1 00 G i_ State: f L-
City: State:
Zip: 3z37 , Phone 5 — he7-ij7 z3S3
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 thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or antl 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 recordin our No a of Commencement.
Signature of Owner/ Lessee/Con for as nt for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF— - J ; r L t ck C C,C x�1�.1
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Al day of N04. 20-L$ by
this _ day of 20_ by
Z. Y`m cy-- m `(12 by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- StatdDf Florida)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Id 'I �.
Type of Identification
Produced FI (),b^p-,, ELLEN VAUGHN
Produced
3+ s, a e o Florida -Notary Public
Commission # p6 2,70079
Commission N Pa mmissi @ Ires
Commission No. (Seal)
"UtiO, octal) 22, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014