HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED 7
Date: a,CO 1 Permit Number:
SCANNED
- - - - s - BY
- -- -- Building Permit Applicatio R"`lV r_"
Planning and Development Services FEB 2 6 9010
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucl - 4s feftnittin9
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResidUTIL[dl
-
PERMIT APPLICATION FOR: �ad� _ S\A. v,e�a
Address:
Legal Description:
Property Tax ID#: 624a 703x (050 Lot No. `
Site Plan Name: Block No. 3_
Project Name:
Setbacks Front Back:
Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generatoroof Pitch
Total Sq. Ft of Construction: � t 2 Sq. Ft. of First Floor: 2-1 a7 : - : - � /
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:_
r
OWNER%LESSEE:
CONTRACTOR:
Name C6e
Name: 6 L)jz
Address: S rJ
Company: O 42oU Z c7
_
City: � P l (L� State
lip-Zipg Z__Fax:
Phone No. g (�,I C -7
Address: (�G Si=. CA 4 D ( V +�- 6-�/{
_City:P4 ( _ State-
Zip Code: S Fax:
Phone No 7772 $1 9 '-� S'd-Z
E-Mail: A-
Fill in fee simple Title Holder on next page ( if different.
from the Owner listed above)
E-Mailri c_�', R eJ -�- r r--� c ICJ k n /Y-4,k
'State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S I LIEME . TAL oW
1 • N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: •
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
—
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVJT:'Applidation ishereby'mddeto obtairi 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 recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License o er ,
STATE OF FLORID Ly
`�
STATE OF.FLORIA
COUNTY OF Q
COUNTY OF
The forgoing instrument was acknowledggd before me
The forgoing instrume t was acknowledged before me
thi�.�n day of 20_ by
thIs., day of F 20JR by
{��a eln l�' �. �C t ac r� 0 •�
� .��Iw C�. �i a c-� u
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 Identific 'on
Produced t L
Produced Z-
(Signature of Notary blic- State of Flori
IE GNENB
(Signature of Nota EGNENS
Ib
Commission No. �S'�Q DFl��` gGG 022023
•,r:�. :'.{Clmper 16, 2020
tii?::SuyN DFANNAN GG 022023
NY GGMI,y l�
Commission No. �T'� �?� . '. I r18,2020
NicUnden'm tors
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REVIEWS
FRO
ONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 8/2/ v