HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: l�®T"(1t1Ja
BY
St. Lucie County
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
ar'cENEo
APR 0+ 7.019 _
Pen1dWncJ Dewar went
St W
X
I PROPOSED IMPROVEMENT LOCATION: I
Address: _5Wd,U
Legal Description: 3-g
Property Tax ID #: /'-, O
Site Plan Name: 5Y �7
Project Name: M IrvkL ��CD11/1� UP. 60
Setbacks Front Back: Right Side:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Qeyvwwe e� �S �Y\r� took own M3 (C1p CYL . 1ymo\ w w 5 V
Cr'�v,A� cUc�F.
CONSTRUCTION INFORMATION: I
Aaaltiona wor t0 a Der orme under this Dermit— check all that ano v:
11HVAC L-1 Gas Tank 1:1Gas Piping
11 Electric 1:1Plumbing ❑Sprint
Total Sq. Ft of Construction: I f IU . (A
Cost of Construction: $ Ll I V1?. S
LJShutters ❑Windows/Doors
Generator 11 Roof = Roof pitch
S Ft. of First Floor: _
Utilities:cnSewer Septic
Building Height: % SA0(
OWNER/LESSEE:
CONTRACTOR:
Name WO L Ck"R
Name: 16hn
Address: u -( E e ►.
Company:)- VIA A4 W-_-rU
City: �Ul(k- yiey-e Stater
Zip Code: N'AY S Fax:
Phone No. Oy - a -
Address:23(0'1 $E H-e(A��1WCYYi Ili
city: V o ( ' S3r. Uk6a State:
Zip Code: Nei 5a Fax: M I A
Phone No. 11a 03LI ��O(0 )
1
E-Mail: MV G�Y�2 I �OS U �:*, Y�Qt
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E-mail: 0 ' 00 (@.COM
State or County Lml
icense: CC -
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
.A'
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
uCJIuly clt/CIMU I IV Ccrc:
Hppncaoie
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
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 recording your Notice of Commencement.
46"
6M
Signature of caner/ Lessee/Contractor as Agent for Owner
Signature of ontractor/License Holder
STATE OF FLORIDA
STATE O FLORIna
^�
COUNTY OF p.n
.
COUNTY OF 6 l' 1it`, F
The forgoing instrument was acknowledg d before me
The r oing instrument was acknowledged before me
fdayof
this Lday of 201by
thisf` 20 by
60nn l a1_ISS
ame of person making statement
Personal) Known OR Produced Identification
Name of pers n making statement
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
��iQ�h 1�1NVIY 4u..�
Produced
�gnatureof
(Signature of Notary Public- State of Florida)
Publi - State of -Florida )
Commission No. (Seal)
Commission No. %rPloriaa
'W�NoWry Public
�S RptN,Rg6t RpRMING
+° F Deena M Sahella
GO 229100
My Commission
`9 t��.Mr
114/2022
:•:
REVIEWS
FR ,eiGtuu
IRES: D
wnbeM.
PLANS
VEGETA ON
SEA TURTLE
MANGROVE
COU
IEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17