HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: S'_k
RECEIVED
MAR 13 C119
Building Pe IA R&licati n
BYST. LucieCounty,'Permitting
St. Lucie County
Commercial Residential
Address: CC7 Du 00 Kck 1: fi 0 X v EXCiE r 1 (Cr /
Legal Description:_ LiA00 IN F54-QAE5 -A 06 LIG-1) Lo} (o (2,52 A6 '37
Property Tax ID #: 3q6 '3 =-'70 D - OW-7 -000 - 0 Lot No.�
Site Plan Name
Project Name:
Setbacks
Front_ f 75. 0 Back: 3 32 � Right Side: _ 3/, ;?- Left Side: 3 1 , 0
ear �r3r�q_1Jor S1-,oA �scc�Z��ti�1y `tc7 hdl(sL
,+umuo�nei wurK io ue perrormea unuer ims permit— cnecK au inai appiy:
`Kechanical _Gas Tank _Gas Piping _Shutters _6�windows/Doors
�ect�ic PIrl'umbing p VsZ prinklers enerator L Roof 6/1aPitch
Total Sq. Ft of Construction: 0 Sq. Ft. of First Floor: 641 38
Cost of Construction: $ -�ll U�!lities: dSewer _Septic Building Height:
S5 Z -Ver e F
ER/
OWNLESSEE.'.
�.
CONTRACTOR
_ ,_,
Name C r
Name: (OW OFjL
Address: V)) tJ LJ M; 1rJEr OS.
Company:
City: PD C+ SFi 1"—Jf / t4 ci t State: !�L
Zip Code: 3 0 F 3 Fax:
Phone No. 779 — 3 70-- f?73-�
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: `I ES 5 AEi/56d+k , tiCi
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ySUPPLEMENTALCONST.RUCTIONLIEN
LAW,INItORMATION
� ^w•, � ,1 j _ °�� t � ,� `, `
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE OMPANY:
Name�Fr�IEis�11fe L�
�y
_ Not Applicable
ANk
Address:
Address y00 9 C7 k4TEcI1o
ACF_ P—d.
City:
Zip: Phone
State:
City: Vk , es
Zip:3y 9 Y •7 Phone: —
Stater
D
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
cornmencing work or recording our Notice of Commencement.
I 1 1 2Z
igna ure of wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO I A
STATE OF FLORIDA
COUNTY OF C �S �C
COUNTY OF
The f oing instru ent was ac nowledgeJbefore me
this,, day 20\ by
The forgoing instrument was acknowledged before me
by
of ,
this _ day of 20_
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Ndffiry Public- State of FloAda
(Signature of Notary Public- State of FloridakT )
Personally OR Produced Identification
Personally Known OR Produced Identification
Type of Ident'ficp i
a
Type of Identification
Produced - C=='.° `°"'= ANOE 't-HUFF - , 'i
Produced
Pubfie - State Of
Commisslo N"d commis "on # Fortda
Commission No. (Seal)
Bonthrou
detl '- Ires IaYP72019(-
ghNafional '
REVIEWS
FRONT
ZONING SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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