HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 l� �° �� SCANNED Permit Number.
'' =— BY LRECEIVED
111i Ian St. Lucie County
Building Permit ApplicationY 1 6 ' 'g
Planning and Development Services , a�tfnitting
Building and Code Regulation Division Counts=— _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
11
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1 233 S, Bkb1_)<5AA )Tld i`d. FOe-7' -nd Exc
Legal Description: 17 2�5 31 N 1/2 (A $>_ 1, y 6-I` N E I
Old 3 cOvlgl Ks/w- (q.75AC)(oIZ noZ-1tato)
Property Tax ID #:
Site Plan Name:
1�� 3 LfJ J45
of NUJ 114 =Les5
Project Name:
Setbacks Front Back: 7J�J'OD Right Side: IKOff LeftSide: I LII•q®
DETAILED DESCRIPTION OF WORK:
1001 II 30 x ?GjxI5111 111 �iv�11 1(1 on neN ounce e
Lot No.
Block No.
qb elecl�ri c a'a plumbinoa no c��i vew�y -
CONSTRUCTION INFORMATION:
MUUIUVIIGI WVIR LU UC CIIUI IIICU UIIUCI LIM P UI I lift-LIMLR GII dpply.
EjHVAC Gas Tank E]GasPip ing _Shutters ❑Windows/Doors
Electric OPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2,250 S Ft. of First Floor:
Cost of Construction:$ 2•�I '13-50 Utilities:Sewermseptic ) Building Height: �5
OWNER/LESSEE:
CONTRACTOR:
"
Name F i,,4_ro q 1-id A>A
1�
Name: TC]MeS PIIA) t
Address: 1133 5• PB'R6G)(SM'1-rJ41 ieD.
Company: Carp2Y-+ AY)uVJ
here
City: Fo2T PIuGf- tate:EL
Zip Code:-3?49L'f5 Fax:
Phone No.
Address: P.O. BOX 7-IU
City: Starm
Zip Code: 3209 I :
Phone No. 35Z'• 91D p' IlF
State:-V'I'
352•-q0)-111.3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: )7 2 i a
(n11. C8rf)
State or County License: (,15C 15101015
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION,:
DESIGNER/ENGINEER: _
Name: Rorida FVIgl1 eeY1pq
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address: L-11 5 1 LP 7Arn iQIM
Tf QI1
Address:
City: P00 Chutrl
Zip: 'fi�d1�0 Phone DI
State:L
- 611- &L O
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 reco-rding your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
Signature —oT Contractor/License Holder
STATE OF FLORIDA
COUNTYOF $ate L Ue
STATE OF FLORIDA
COUNTY OF $PA-1>FCLF2-0
The for oing instrg ent was acknowledged before me
The fargoing instrument was acknowledged before me
fog Ih°tAy
thismFdayof Juntl/ 20[Q by
this 20�by
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Name of person Making statement /
Name of pers n making statement
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identification I
Produced FlcriZQ 5�cke �riVQi3 (+(tNH�q
Type of Identification
Produced
B.
41" 4.
(Signature of Notary Public- Stat 1prNatrg " e, Aims M =
(Signature of
N •, FFs7s
Commission No. FF q � (S.gal)
Y
o Notary Public State of Flonoa
Commission N ..' Mada R Burgin (Seal)
i9%• •.:YBLI171 Q� �`
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N my commission FF 912775
osno° Expires00/252019
PLOPN�.`
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Rev.8/2/17