HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE'C''' `, PLETED FOR APPLICATION TO BE ACCEF i cii
Date:
Permit Number:
R:CEIVI]D
Buil ' g Permit A ication FE5 2Planning and Development ServicesBuilding and Code Regulation Division ST. Lucie ty,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-157 OP
ercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �erdya�'�o r\
PROPOSED IMPROVEMENT LOCATION:
Address: a.--7 �) 3 �A PA / PN -> jsy?
Legal Description: LcA cye W2 G sl th wl,l vvie Ktc- t1S-5 :
Property Tax ID#: C)� o9c)LI —CX>O— Lot No.
Site Plan Name: Block No. L/S
Project Name:
Setbacks Front Back: Right Side: Left Side: SCANNED
DETAILED DESCRIPTION'OF WORK: St. Lucie County 111
�r pooV'.pperiru�
4
NSTRUCTION INFORMATION:_AdUfflargit
ermit—c ec a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: ScFt. of First Floor:
Cost of Construction: $ 3dd - O Utilities:Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name a% 33 N NVA-To LL C
Name: v\vS ; rye bot9 .
Address: Li 169,c6 )V, ki, f
Company: (yyec�p CC>�.s+ VC. C+ec, Co'p
City: State: Fl
Zip Code: Fax:2
Phone No. 7i�- �9i(- d13Ci.
Address: 4SLce, N. kiNSw/ .
City: �-O' ? i2 ,o Stater
Zip Code: Fax:
Phone No. 274- r! 7q- 933,_
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Coy--
State or County License: (' 6c,. i SOG of O Q,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ESIGNER/ENGINEER• _Not -Applicable
Name:
-MORTGAGE -COMPANY. -Not -Applicable --
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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 work oLr co Ing your Notice of Commencement.
i
Signat essee/Contractor as Agent for Owner
Signa ontractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OF L (I 71{ .
COUNTY OF S-1. Za�ci t .
The for oing instrurneafw acknowledge efore me
r
The forgoing instrument was acknowledged before me
day AVxue�j by
this day of 20�by
this ___�j of rl 20—E
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 <_ L
Produced
_t.r..;� 310Hft0 .T 93
Vim• a PIREB:Janua
3ona�dn� nn�unaaruturo
(Signature of Notary Public- State of Florida I
(Sig e
Commission N I"yob, KAREN S. (9♦6OSEN
Commission No. (Seal)
;: Florida -notary Public
•_ Commission # GG 207484
?�noa: My Commission Expires
REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
FRONT
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17