HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO:...LETED FOR APPLICATION TO BE ACCEPTLu
Date: Permit Number:
�jly-� .. RECEIVED
Building Pmit Applicati eron
Planning and Development Services I ST. Lucie County, Permitting
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: rFr c.E • Cos-v-,V-5 Co�.vati�S
PROPOSED INPROVEMENT LOCATION:
Address: 1'9i'D CoC>Y S`-t I t s
Legal Description: SCANNED
Property Tax ID#: 2,36s•5X-0005-000.2,
Lot No. y
Site Plan Name:
Block No.
Project Name:
Setbacks Front ✓ Back:
Right Side: Left Side:
C-$�w 9-1-0c tt- U �-rAj- la dQr
r2x1 2t t`u 24`, anCA (t-1-`c N) ku'" x \ b" x (o
- cnecx a
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (�, co 0 Utilities: —Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name lL'L.% NW IC,
Name:��tta 3l^t- %z FY
Address: LQjto C-bDid t._A
Company: 1,
City: q T State:
Zip Code:I `ids Fax:
Phone No.
Address: t14N I, Ile
City: R✓� P?c,•O- State: tr—
Zip Code: 3y q S 7 Fax:
Phone No(- 7Z ) ? 1%LA -C 14%
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail It-DE'DE5(6AW1A1L .
State or County License t l G 133 l 67-1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALG III � LIEN LAW INFORMHKONZ.
DESIGNER/ENGINEER: _ Not Applicable
Name: U LL 1.y r'LC. Et
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 6't �` i sw �1 t.rwloR-� Sr.
Address:
City:�III SC • W L1 L. State: FI
Zip: 3`tg 2,J Phone LU2)29&--ggg8
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 iri'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 your Notice of Commencement.
Sign a of Owner/ Lessee/Contractor as Agent. for, Owner
Signatu . ontractor/License Holder
STATE OF F.LORIDAtt
STATE OF. FLORIDAk.
COUNTYOF L1 ,��; ' '
COUNTY,.OF
The
The r oing instr m nt was acknowledgeO before me
day 6
The r ing instrume t was acknowledge efore me
�,
of , 20 by
thi d y of 20f�by
ame of person making stat ment.
Name of person making state ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi Non
Type of Identifi tion
Produced
Produced
CJ --
(Signature of Notary Public- State of Florida)
(Signature of Notal e )>vcr StatRA pji a I ELSE •.
�k=State of Flor!d -Notary P:,;•:�;;jq
Commission No. '-
E. •='Commission i..
Commission No. in (��ijj207k%t.�
;;;+>�•:, •- KAREN S7NIELSEN
•°j—My Commission Ex ir.!: p
''w dune 1z,'2022p'
'
_•
•e Commissio'N
GG 207484
REVIEWS
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REVIEW
REVIEW
REVIEW
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RECEIVED
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DATE -
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COMPLETED
Rev.6/z/1i y r f /