HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BEACCEPTED
Date: �c ' 9• % C% - Permit Num /9-l � - c �
SCANNED -_ ,
-x
BY
losses 1� St. Lucie County --
NONE[" OCT 9 2019
Building Permit Appli ation
Planning and Development services Permitting Department
Building and Code Regulation Division i St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: TDS(� NDZ�
Address: 7 5 1 ti K6e;E 12V G G2 E-UK. D K P SL- PC 3 q q9A
Legal Description: i' irCr- , G' OWe,S5
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front.
`Z-0
Back: J(& Right Side: !�I 14 Left Side: J� i
Lot Nd.
Block No.
IAR��LiMVi}I�O�OF
p
nuuuIundl WUFM w ue perrormea unaer curs permit -cnecx all znaz appry:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
'E&ctric, _Plumbing —Sprinklers ✓enerator r—Roof Pitch
Total Sq. Ft of Construction: & w- Sq. Ft, of First Floor:
Cost of Construction: $ S 9 q 5 Utilities: ✓Sewer _Septic Building Height: ILIA
NamJ J,0579
Address: 7-6 G2C�Gi CDR
GQ,Y 5.J1"i')Dbac
Company: G��':lhDDi2t�=ML-Z-:5G7-
city State: ��
Ad�dress:Z� '��}213tii� D 2
Zip Code: Fax:
City: 1% CW- Stater
Phone No. -7-72-57q - 9 01) 0
Zip Code: .3z`I6® Fax:
E-Mail: NIA
Phone No_ - 77 7-36 b - z.Z)
E-Mail GGA)CDA-1,646T.1U G
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
n value o. wnsimulon is vua or more, a nKUnueo notice or rammencement Is required.
DESIGNER/ENGINEER: i/ Not Applicable MORTGAGE COMPANY: I/ Not Applicable
Name: Name:
Address: Address:'
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V Not Applicable
Name:
Address:
Zip:
BONDING COMPANY:
Address:
city -
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. Luce 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
cnmmencine work or recordine vour Notice of Commencement.
J Ct �l d / / 1i6�2Pu
.,o
Signature of Owner/ ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA., /�
STATE OF FLORIDA QQ `
COUNTY OF/Ctµ21
COUNTY OF ['C/lIAPJL
The forgizing instruTpLwas acknowledged before me
The f,Q�ing instru Mpyt-was acknowledged before me
^day 'by
this tlay of s/A�YI . 2oAl by
thisr of 92U"
o
6 v Y S. m OO ✓1.1:
(Name of personacknowledging)
/.1AA�y��Gvl�17N
(Name of person acknowledging)
- �
ri►�ONtaryy
(Signature of Notaryublic- State Florida)
(SignatuPublic- State Florida )
Personally Known ✓ OR Produced Id nY ton
Personally Known OR Produced Identification
Type of Identificatio •m••••• „ VALUA tSMEoN
Type of Identifl
Produced 'i� gMMISSI0N8G013B/89
Produced ."i< :". WILLIAMSURGEON
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:i Ei�IREB:au etaE�zt
=. .= MYCOMMIssIONaGGt�188
Commission No. ' sadTo le UMOUnduwftn
Commission No. '7/ �Iw :Augq 9(nt
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
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DATE
RECEIVED
DATE
COMPLETED
ev.