HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CONTETED FOR APPLICATION TO BE ACCEPTED
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Date; Permit Number: 5
JAN 241019
v Building Permit Application Pe St! LlucleDeart
County nt
Planning and Development Services
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 �) rl lV(� 2 7)e_ M e r-z
Legal Description: 31)bl R rJ kky4e ESfo-7 eS U►J 1 ,i 06 6)D e/e_
Go%5 3f1�l-39
Property Tax ID 4: ?✓ 00 - l00 %— 0 0163 — o 00 - S Lot No.
Site Plan Name: YYi'ericA es Block No.
Project Name:
Setbacks Front as, Back: /5 ' Right Side: �d Left Side: /y
DETAILED DESCRIPTION OF WORK:
�Grounc� �1 mM.tniJc DDT W, �,��'
CONSTRUCTION INFORMATION:,
AacIrtional work to e nertormed under tispermit-checkk all apply:
0HVAC Gas Tank ❑Gas Piping ❑Windows/Doors
_Shutters
Electric Plumbing Sprinklers E] Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost Construction: 45, 77 g , 00 Ll
of $ Utilities Sewer Septic Building Height:
OWNER/LESSEE:
-CONTRACTOR:
Name .SO
enQe
Name:
W"e_ w) , A2 e:
Address: 60 17., H1rnex-I-oJf1
Company: 021ZON Do15 _T4gC.
City: �ie-r e � State:r- -
Address: 54a el 5 S-)-
Zip Code: 34e)u Fax: -'
City: lef de; State: -F'?_
Phone No. 7 i J l �' Da SiD
Zip Code: .3Lr-i 8 1 Fax:
E-Mail:
Phone No. 7o;Z SDI- 8 SD
Fill in fee simple Title Holder on next page ( if different
E-Mail:
h o r12A N D'O)5 . saA tnfr L..
State or County License: clqa
from the owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
M
SUPPLEMENTAL CONSTFUCtION,
LIEN. LAW'INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: C7 f 0r' A"A' 5
MORTGAGE COMPANY: Not Applicable
Name:
Address: /,A /1 S L}Ms,
City: IdAr Wln .. Z7V H
Zip: Phone 305
State: fc�r-
879- 0541
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 Counter 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
commepcing work or recording your Notice of Commencement.
DO
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tur of Owner/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
ZiTE OF FLORIDA
COUNTY OF A�GLt.I
STATE OF FLORIDA
STATE
COUNTY OF
The far oing instru t was acknowledged before me
The forgoing instrument was acknowledged before me
this /2 day of 20a by
this-L7 dayof ,f 19_C, 201 by
d U t 1 1
wade- m aQ4'.�Pr
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known t/ OR Produced Identification
Type of Identification `
Type of Identification
Produced ✓
Produced
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(Si ature of ub1 i a
NOTARYI L
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Commission STATE OFFLOftlpall
(Si ature of Nota c-3@ateM dIt94HJam
NdTARY`PtfBUC
Commission No. SYTEOFFIjj
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319f2020
Comn* GC-W2559..
E..plres
t Expires 3I9/2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
Ilia
DATE
I/
COMPLETED
Q
Rev.8/2/17 1 if