HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5�6� \ Permit Number: �)S-C zl
SCANN� .,
BY =RECEIVED
St. Lucie CoupBuilding Permit ApplicationPlanning and Development ServicesBuilding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line � e^\ I
PROPOSED IMPROVEMENT LOCATION:
Address: `-\ �Yb C oU,t
Legal Description: V\Oy0y-C. C-(x.v \o COO t�ir � CI0b V rat Ar a' LOt 1
Property Tax ID#: \3oil—q6\—Od�D�a- 000 —_' Lot No. 1u,I
Site Plan Name:
Project Name:
Setbacks Fri
Back: 15 Right Side: 7•5 Left Side: 7.5
Block No.
DETAILED DESCRIPTION OF WORK: II
hst'A\�'C�or` of �Jyt�t�- coal ciecK � eq��Phn-�✓t�
CONSTRUCTION INFORMATION: III
— cnecK a
Tank UGas Piping
LYJElectric IV Plumbing L_JSprinl
goof •300
Total Sq. Ft of Construction: ccK'_ Le `I 0
Cost of Construction: $ S\, a S b\, O d
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Io Lv ar
Name: POO\S h.l C'7a `=y1
C.
Address: OMO g i r\e r /k LOy f
Company: TC r
City: erect, P -\ er" State:
Zip Code: Fax:
Phone No. a. Off- — 5 U 4
Address: '9060,U �caera\
i�t War
City: Qora_ S� i )Cac
Zip Code: 3 A `i (; a Fax:
Phone No.-'+
State: FL
E-Mail: 'IC e \, (,OVY,
Fill in fee simple TitlLdHolder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: U t _ \ 4 ' ,
3 3 t
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: a a Name:
Address: l 4, 01 pR Address:
City:5_c P'crc.e. State: FL City: State:
Zip: 31A A 1 A Phone aacl - 01 - 1 43`{ 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
rnmmPncing work or recording vour Notice of Commencement.
for
Signature Contract License Frolder
Signatu— re�of Owner/ Lessee Contractor as Agent Owner
of
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF MARTIN
COUNTY OF S� • : C�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 27 day of APRIL 2019_ by
this day of LF rc� 201 by
THOMAS H LUGAR
L
Name of person making statement
Namb of person making statement
Personally Known OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced DRIVERS uc
Produced
-�-
gna u e of Notary Publi St
on
a
(Signature of Notary Public- State of Florida
Commission No. �)
r., •;
4 .'..
.•
G eth Ellyn Wood
IS Iublic,StateoiFladda
Cotnmisslon No. FF 988518
,n Notary Public State ofp� oInd
Commission InaBowirL�eal)
My Commission GG 2on33
p!„ • •
My Comm. Exp. May 8, 2020„
p•
nS Expires 03129I2022
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Rev.8/2/17