HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COIW.-__'IED FOR APPLICATION TO BE ACCEPTED
Date: Y %S Permit Number: J��� D 0
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-- —���� -- --- Building Permit Application St.O_uciecountN
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
PERMITAPPLICATION FOR:
PROPOSED INPROUEMENT LOCATION:
Addresss2s--:��-� rqq 8t-EArj zel, AU
Lega eldriptiofi` 'SyrDwS, 1-12 L6T" -7 i s=55 S zd Fr l l� I +c) eiv j /[ �S� N
Property Tax ID#: 9Lt29 .5-62- BDFJ -7 re& D Lot No.
Site Plan Name: _ Block No.
Project Name: Of rlli%jyeye� guS W e5S P&f"4-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
2-Kt0y6 T� 4 C-ieAveltQ� �.sc� car �Ew vinaol�c� r�Innw,�,.5
f?vu— eeDc-c>_+e
CONSTRUCTION INFORMATION:
Additional work to be pertormed unaertrus permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters -Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction: / L ,L90 Sq. Ft. of First Floor:
Cost of Construction: $ �7L Oi?97- °o Utilities: _Sewer _Septic Building Height:
OWNER/LESSE-E: ;• ; n
_� NTRACfOR:
Name Kh"--X-
Name:
Address: i
Company: L�'fOAT&t,�a*.fr�, f r1
City: IuQTGrj State: �
Address: 3Z71 L9I ekpt7 — "r-
City: i'r t, an&k Stater
Zip Code: 3333 Z Fax:
Phone No. qsy 973 69W
Zip Code: ,3¢�9gZ Fax:_7]Z-�6(-blt�
E-Mail:
Phone No 777,- 2-16 — 86Li;:1
Fill in fee simple Title Holder on next page (if different ^
E-Mail
State or County License _!02
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTi4LWNSTRU • N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: /14zvet., Kona /E ✓erJ
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: G
Address:
City: Pf L State:
Zip: a?W' 'i, Phone t-.z q&t, _!Moq
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: .I
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
rnmmpnrina work or rprnrdina vnur Notice of Commencement. /7
Signature o r Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this _ day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
dl
q
DATE
COMPLETED
Rev.7/2014
JOSEPH E. SMITH, ---7RK OF THE CIRCUIT COURT - SA`LUCIE COUNTY
FILE # 4030354 C`OOK 3707 OEAGE A322, Recorded 'F13/2015 at 11:23
NOTICE OF LOMMENCEf'Ew
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STATE OF FLORIDA
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