HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: - I -Z -� q Permit Number:
SCANNED RECEIVED
02-Suff, BY
St. Lucie County APR 2 4 2019
Buildin Permit A licati �i
g pp. Lucie County, Permitting
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: V D IJ 5 D Vw
- ,
PROPOSED INPRC►VE{VIEN;T LOCA# LION':
ir�ra«• qyo� Sc�CaC�ti(zovGHT' T L FL_
Legal Description:
Property Tax ID#: zz,' S�7• �I��� �� Lot Nd.
Site Plan Name: $ o M Block No.
Project Name: 5 0 w\ C,rt 5
Setbacks Front P P) " Bach: 1,40"t Right Side: b� Left Side: y -0
DET>�iILED 00CRIPTION OF WORK:
Srvs7'arrw�cro 5-t;,7/Vo--7'6Y 6C�uc�2rn�or�
CONSTRUq,I10KINFORMAiION: -�
_Mechanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors
'iElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: N/0`I
Cost of Construction: $ % Z, Da Utilities: —Sewer ✓Septic Building Height: W -F`!
OWNE}i�L�SSEE mr �. , Y
CQNI' -A
Name! 170iJ Sl7.i;�GRS ':.:. i
N�ea>,::
Address: `iD�/
ScR (L 33-D Two G
Co(npariy G ;;1� �OD2i: GLtcT
City:��, -�� �--ST:.-LVGl:yY _State- �L
Address: ZIg GAST'%�11 �aR iJ2
Zip Code: Fax: VV/0q
City: 1/r✓lbo r,6;GO State: FL
Phone No. 7, Z - 7 `i 7 - Z06�
Zip Code: 3 z96 a Fax: vU (VF
E-Mail: ^/10
Phone No 77 Z - 3 6 D - ZZ/S
Fill in fee simple Title Holder on next page ( if different
E-Mail_ U5 66LKyl Ca Y14 64-r N �
from the Owner listed above)
State or -County License Z=C- / na 6 1 Z Z
•• --•-- —• -- •. �........ �:�.,� �, . n�wnW w nuucc ur wmmencemeni is requirea.
--
••�+��.,(Yr�YrB�..4 C� �/'ST �.. yi,W y� r���+�}'e r{��j
'JL'Al`er �4: �I�I L`b�1Y:JAA1� )Vt9sUE a.:1YY riyfr{Jr � i'"
�t As ak t
�11V1 rY
'yh 5
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:
vvvivcni wry t RACli OR 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 vnur Nntiro of rnmmc... m ..t
Signature of Owner/ Le ee/Contractor as Agent for Owner
Signature of/Contractor/License Holder
STATE OF FLORIDA.4 QQ .
STATE OF FLORI%�.I.
COUNTYOFp>!ia�t /L.woJ
_�
COUNTYOF /P
The for ing instrume was acknowledged before me
this ay of w.to 20Zf by
The for ing instru D was acknowledged before me
_ .
this ay of d2u4m . 20,a6y
(Name of person acknowledging)
(Name of person acknowledging)
---1e2Cr�rgd
(Signature of Notaryd ublic-State Florida)
(Signature of Notary Public- Statepf Florida )
Personally Known OR Produced Identification
Personally Known OR
Type of entification
Produced Identification
Type of ldentific '
Produced } WILLIAM SURGEON
9MMISSION#GO138409
Produced ,"Ns'�:''*Q WILLIAMSUROEON
,. .
EJWIRES:Au99uet28,2021
Commission No. `
.i fi. WCOMMISSIONp00t38489
q' "i
ceafiiu(S9tlipWoUndmnlun
Commission No. t3%PIRES;�9t%&pp21
on iu No Pu Ifc UrvrvGGnurl4n
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.