HomeMy WebLinkAboutBUILDING PERMIT APPLICATION2
All APPLICABLE INFO MUST BE COMPLETr o'�011 APPLICATION TO BE ACCEPTED
Date: a+ Permit Number:���a.-�`���
:. RECEIVED
Building Permit Applicati n
Planning and Development Services . DEC 1 c018
Building and Code Regulation Division ST. Lucie County, r
2300 Virginia Avenue, Fort Pierce FL 34982 --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: 30 e-Q -
Address: `�- L D-,
I &Iy2 Gv�
Legal Description: YLr�— F SID ��cl� c� �-0"(' ( 2, S �309a-69-9-3,Y
Property Tax ID #: r756I ^ 17 ( ST —coo .S Lot No. )1;1
Site Plan Name: -VC6-4 ti-A Block No. 9—
Project Name: KO3 ppn IAA
Setbacks Front 4 '�S Back: 60 Right Side: (50 I Left Side: 36/ SCANNED
ov
Aaaltional worK to be perrorme❑ unaer inls permit— cneCK au inai apply: ; •�
_Mechanical _Gas Tank _Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator v Roof 12, Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 3 10
Cost of Construction: $ �/ 6D Utilities: —Sewer _Septic Building Height:
O�AINER/LESSEE ._
GONT '
NameD.e Oyab. P-.6W0tvy-'
Name`'
2
Address: 1+11Y22e i�A� wl�
Coinpanye
City: i'�'I-' 1 1State: [-L-
Zip Code: 314' 1 R'— Fax:
Phone No. i-12 2-1 6 O
Address: _2
City: State:_
Zip Code: Fax:
Phone No
E-Mail:do6)NrAJiloiNVS (0 "J. QQdA
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.
.,
UPPL:, ENTAL C9 11 +. N L1a INFCJ;R TIf0;1
DESIGNER/ENGINEEK: • _ Not Applicable
MORTGAGE COMPANY:
Name: 4 '
_'NotApplicable
Name:
Address: a`� `' °�' °'
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 Assoclatlon 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: roorri'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
commepwgWork or recording our Noti e gLfiCornmencement.
A V2"
Signature of Owner/ Lessee/Contra for as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S r L-Lk ct L
COUNTY OF
The forgoing instrment was acknowledge before me
The forgoing instrument was acknowledged before me
this \ok �Vt.C, 20 I by
this _ day of 20_ by
Da.bot4�r. Babb°�y�j
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
Produced k -
Produced
(Signature of Notary P m, « �Eavt MNiIEGIVENS'
(Signature of Notary Public- State offlorida )
{ip.°'•`•• MYc MI ICJN"000022023 "
Commission No." - p embor10,2020
Commission No. (Seal)'.
sy oar` Notwy publkUMeiwriters
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.