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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �`1�1�� Permit Number: SCANNED BY • St. Lucie County Permit Application :RECLEIVEDBuilding EP Planning and Development Services Building and Code Regulation Division 5T.e Going 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 ° f` P , r OP NER II"N OUEIVI NT LQ�C•AxIONs ` ° ;, Address: ?e bc. 1 ' i Ba /I Legal Description: Inr��rrn 4,le z�51& es /bJ-,0q &K - % 16m,AP3ylo2rl 0�393o-zzz� PropertyTax lD #: Lot No. 7 Site Plan Name: Block No. Project Name: Fa u monl� (i i i Git Setbacks Front Back: Right Side: Left Side: cDEfAIL•ED DESC IPyTI®N OF WORK: air"; _,_. , . .r. K._ CQ; SifRUG'91lON INFO MATI©Nt °x f' `f" Acicirtional wor to e e orme under tispermit-c ec a apply: �HVAC —Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors Electric 0 Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ aZ11C6,' Utilities: Sewer Septic Building Height: OWNERS/L7ESSEE: ,GON�TRP,C"T�OR,��r,'" � „� � �a�•; �}`•, ° tatlUc4 Name: KobCCtZ Company: So) r5+ern5 Name ��, Address: P,'Aelr-ee. Or City: iD t"i' ie.t•[� Stater Address: )ip0 SmrxIS�L fN.IP_ City:l .tj P Ce:,e Stater Zip Code:3u4S2 Fax: Phone No. 7i -- 37d Zip Code:3t(A87 Fax:-772- 4InIg - iq 3_7 E-Mail: Phone No. '47a Li� 14- 2/r26.,3 Fill in fee simple Title Holder on next page ( if different E-Mail: SWQO\our ern ufa r . Cin n, raCI'N State or County License: C'.VC cis from the Owner listed above) If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. '1/ SUPPLEME TAC GONSTRRU ON LIEN LAW. INFORMATION: DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: 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 commencing work or recording your Notice of Commencement. X �itr rJ�' X /`G (1 P ✓t . 1 MA✓ == Signature of Owner/ Lesseegontractor as Agent for Owner Signature of Contractor/LiLefise Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 5-1- 1iAc e_ COUNTYOF -SSA, L ae, The forgoing instrument was acknowledged before me The for oing instrument vyas acknowledged before me rdayof this gday of�20 1Q by this f2 <0 +. 20ja by Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification _,L Type of Identification Type of Identification Produced— Produced /p Public- Stat f (Sig6aturelof Notary Public- Sta lure of otary r' 361295 Notory Publlo State of Flo Commission No �� elslprie Sarah Blystone My Commission GG 361 Ea rtr Ngqt�ery Public State of Fla Com fission No. SEN=r Sarah Blystone 5 My Commission GG 3611 ti Expires OB/242n27 +�r1V Expim5OB/242623 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17