HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE [NIP MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I _
Date: I tco Permit Number:
• / LLL
-' -- QidingIPermit Application s _
Planning and Development Services Pliahc
Building and Code Regulation DivisiA • Lucie COUnty, Fj,
2300VirginiaAvenue,,Fort Pierce FL34982 - -- - — -- -
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residentialt.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'PROPOSED IIVIRROVEMENT,LOCATIOW"
Address: j� 0 (Oj� L,a Fa % ! b ✓ % p S ! a L 3'f
Legal Description: /� PS�r P %'%j v j g y/ O J�17 a s e L7' �} Z j LIE
PropertyTaxlD#: 3,zs�\ <)u > c QNa CDC]o Lot No. L16
Site Plan Name: 2C'C•' L-L 1,eL-o _ Block No.
Project Name: I SCANNED
BY
Setbacks Front a Back: I5 Right Side: LeftSide: /U
St. Lucie County
'DETAILED DESCRIPTIOWOFWORK
V
CONSTRUCTION_ ,INFORMATION:.
AGaitionalworktonersertormecl under tispermit-check all apply:MC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
is 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sy �Ft. of First Floor: `
Cost of Construction: $ -.' j OUi d Qd Utilities: i-J Sewer _Septic Building Height
OWNER/LESSEE: ". ` "; ',.'CONTRACTOR:,
r 9
Name I/CA, Ce. i MArceLLimo
Name: f,)4L/`ID ✓LPs)?i
Address: a WG a a. / Cr.
Company: H t� Hr& /3u i Ld P✓'S Z-lc -
City: - P(P r v- 59, L � c t P hL• State: _
Zip Code: 3 L/alb 6 Fax:
PhoneNo. 5,1(- 91t/-S,090
Address: `do r i d of 4 4v-P .
City: M el- y w r...e eAf L, State: /-G -
Zip Code: 3,29 S1 Fax: 321-952-86o g
Phone No. i7o2- % 13- 0 e 8S-
�9
E-Mail: VySS 2D" MZ)Siz
Fill in fee simple Title Holder ege Jif di e e t k
from the Owner listed above)
E-Mail: hgi k-/< b at t cie rs eve t� 6 PGCSo.. iti . A- rT
State or County License: Cg C o 5965 /
is vama or construction is,%zbuu or more, a RECORDED Notice of Commencement is required.
\ Wilk `-t LOW
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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 record' o�e of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sig ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S �r. L V e \
COUNTY OF S a
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisdaof � 20
thig:1 dayof do 7 20 Vobyy
(Name of person acknowled cng)
(Name of person acknowle ing )
Notary P lic- State Florida )
(Signature of Notary PublieJState of Florida)
(Signature of of
Personally Known OR Produced Identification
Personally Known OR Produced Ide '
Type of Identification
Type of Identification Mpµce ONEMS
Produced L t L PEGNENS
\tplMli 60
GG
0
Produced " 'oER#t% ewgOG o22623
e.gq'...";ti4 Coyet 16.2020
'
\O %6.2620
Commission No. ` �RME� v0emn
+ti:
Pl0.ES:De eMd�R
Commission No. ty ,may
. a Nomtl �
'•'...fl
.wPDN`tq�
REVIEWS
FR
ONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COU TER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
1014
DATE
COMPLETED
ev. 7/2014
.,��� •�..� �•vn.r on: _ Ivuc Hppncaoie MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone -
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,
accessary 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 lenderattorftwv before
_Signature of owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing mstrurrrgg�ent was acknowledged before me The forgoing instrument was acknowledged before me
this i J day of � 20 %by this _ day of . 20 _ by
(Name of person acknowledging)
(signature of Notary Public- state of Florida)
Personally Known OR Produced Identificatjon _� Personally Known OR Produced Identification
Type of Identification Produced %t - yes( (� � a n SA I Type of Identification Produced
Commission
CWdWN DEMERS I Commission No.
NOTARY PUBLIC
(Seal)
Comm# FF065960 II
Revised 07/15/2014 t ;� Expires 10/24/2017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS