HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPUL.^- FOR APPLICATION TO BE ACCEPTED t
2AZDate: Permit Number: "
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
RECEIVED
Building Permit_ApplicatiLnPR 29 2019
ie county, Rafrn1Wnc_,
Commercial . Residential
Address: Z3C3 ZV-{ . t %{ 349 . Z
Legal Description:
Property Tax ID #: O a.z - c007 - Cw 3 Lot No. %
Site Plan Name: Block No.
Project Name:
St. Lucie County
Windows/Doors
.electric _ Plumbing _Sprinklers _ Generator ,-Roof Pitch
Total Sq. Ft of Construction: (2 Z_
Cost of Construction: $ J 6; (300
Sq. Ft. of First Floor:
Utilities: —Sewer Zseptic
C
Building Height: 13 'G "
OWNER/LE-SS€E:
CONTRACTOR:
.,_
Name ra4ply{e.) 2, ^�_
.rr,r.vR�.3�' .'ke+3r-�S�J
Namet^i=
Address: Z c', " �tJC' rlwwoElc I -A
CQrnpgAY. - �• l ` 'c A �•JSiLuCT�.i
City: _ _ e�&c-7 State: _
Zip Code: 4(3SZ Fax:
Phone No, T)Z- S&431,1
Address: Z 3�5 IZ• U GZ (( is U vkoc(c W
City: Stater
Zip Code: 3YcicZ Fax: 7)Z-/W-03ZS
Phone No -)7 Z- Z t - I t I�A
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 7�0r Ja
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
4_
Sty MEMER
110N LIE lA . INFORMATION:
DESIGNER/ENGINEER:
Name:.!a�6 ,crams.
_ Not Applicable
7Aul OMCR
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:_ 138 5C I�l �z,a J�g �d
Address:
City: !� I_
Zip: Phone
Stater_
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Ph
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, der or an attorney before
commencing work or record ingye" oti ce of Commen
Signatuc o : ° caner Pe/.Contractor as Agent for Owner
Signature of C ntZA
or a Holder
STATE OF FLORID
��1Ci2
STATE OF I
51 �C ��—
COUNTY OF
COUNTY OF •t
The for oing ins ument was acknowledged before me
The forgoing instrument was acknowledged before me
this_VMyof ( 20_V�_ by
thisQS_dayof Qg V 20 nby
`
JOy e E—\1 acr\
wLA I�f P
Name of person making statement.
Name of person making state ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu ic- Stagy lo_r d�RBFA AGaODIYAN
(Signature of Notary Pu a o�w,�J y1
GCI tSBtW
�t0��y
Commission No. _12 S /�t21122
(�Marfi20,�22
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Commission No. 4 41 F �q�p
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e
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a rAWTINof FLW o` rs•
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/L/ 1 i
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: 6 i�.1 Grp Name:
Address: lo7to B" i3ssTlr4vv4%koz Address:
City: St- State: �(_ City:
Zip: 3q9Z� Phone:_ 772 7 S-- b`I(_ Zip:. Phone:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFF.IDVIT: Application is hereby made to obtain a permit to do the work and ii
4 cerdfy:that no work•or installation has commenced prior to the issuance of a permit.
t Applicable
State:
indicated.
St. Lucie Counttyy. makes no representation that is granting a permit will authorize the permit holder to build the subject structure. .
which is in conflict with any applicableHomeOwners 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
WARNINGIO 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, consul er or an attorney before
commencine work or recordine vour Notice of Commence" .
Signature of Contr ctoP11icense Holder
ign ure of Owner/ Agent/ Lessee
STATE OF FLORIDA
STATE OF F
COUNTY OF
COUNTY OF
Th forgoing instrument was acknowledged before me
thieA,day'of Cr " loft by
The rgoing inst ment�as acknowledge before me
-this day, . 20t 1 by
(Name of person acknowledging)
(Name of person acknowledge g )
"C Q-4 M�u f
?�Q� ��
(Signature of Notary Public-S ate of Florida)
ignature of Notary Public tate of Florida )
Personally Known OR.Prolggd lder�ir�r�y
Personally Known LOR Produced Identification
i BNtBM A06 WX
Type of Identification Produced. �6
Type of Identification Produced aj°'
(� * •
Commission NdG-Ca `� �'(S , , .
"Commhim#GG198133
Commission NoC��* (S6t61'(e.+I hY9.
Stp�R
di
M10r�flnliltlpalrm6ryS11Mkp
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
EEEI
M
ED
Kev. //1U14