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Home My WebLink AboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED r D F.O}R-,A�P,rP�ICATIO TO BE ACCEPTED Date: -3- 1 � LUO ( Permit Number: SCANNEDRECEIVE® • _ St. Lucie Counbi 2 8 2015 Building Permit Application Planning and Development Services / O� PERMITTING Building and Code Regulation Division C , St. Lucie County, FL � 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 III A Address: Legal Description: LOCA PropertyTax ID #: 3�/yS0/IODI�o�� Lot No. Site Plan Name: �" cC�� Block No. Project Name: /// "� �7i5 cad' /�G A-) Setbacks Front Back: Right Side: LeftSide: DETAILED DESCRIPTION OF WORK: III 1. rorc�2ivi e- CONSTRUCTION INFORMATION: AClaitional work to e e orme un ert ispermit-checka Piping apply: �j Shutters Q Windows/Doors BH'AC El Gas Tank OSprriinn�r Gas _ El EI Roof Electric Plu%pi % Generator , /mod/ (/ Total Sq. Ft of Construction: 9a �! - SicN Z S . Ft. of First Floor: = Cost of Construction: $ !W<Z)_ t 57GV 7 Utilities: USewer USeptic Building Height: C OWNER/LESSEE: CONTRACTOR: Name Name //G$Y a Address: � Company:d6L B City: 210o-wXD State�f Zip Code: Fax: Phone No. �&—hsz- ,60 � Address: nO/6 /Af-Al City: //6=2 Zip Code: ?:i77?, Phone No. W3 - %77- State:dr—e. Fax: 6, 9 S"9 E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail:112i/1//�.</rN/QL�/6.i15 /2Gn�i4� State or County License: G<'�3AOSyi/� 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: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: 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 recor inp vour Notice of Commencement. _ Signature of Owner/ Lessee/Agent Signature of Cont ctor/license Holder STATE OF FLORIDA STATE OF FLORID COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forpoomg instru ent was acknowledgedbeforeme this _day of . 20 _by this�7 day of 20 IJ by 1 -4 urres s (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public- State of Florida) (Signatuile of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known o "9"j4,Produc�ARB�fit+tllt1!!h Type of Identification Produced Type of Identificati rr Notary Public.- State of Florida • My Comm. Expires Sep Commission No. (Seal) Commission No. �'-;+ Commit 5s�(g��Iff F 149166 „mno 1fraNatlobalNat®yAssn. Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS 'VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: III DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable " Name: Name: Address: Address: City: City: Zip: Phone: Zip: I certify that no work or installation has commenced prior to the issuance of a permit. Phone: St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in co 1%ict 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 inspeq[oP-ff-y-6`umfe-nA to obtain financing, consult with lender or an attorney before � s Signature a or/L cen STATE OF FLORI / STATE OF FLORIDATPSCO COUNTY OFi6g�� COUNTY OF � The for oing instr ent was acknowledged before me The forgoing instrument was acknowledged before me thls�,dayof� 20/Sby thiso2Sdayof IMP 20 Eby (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 t//ad idpraifimtian Type of Identification Produced Type of Identification P dµ . ••••f KAREN SCHAI I Mn I $•; Notary Public -State of Florida Commission No. (Seal) Commission No. _ .4 My Cor(dea*lres Sep 14. 2011 Commission 8 FF 149166 Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS I ns o DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name - Address: -- - --Address:--- --- City: State: City: State: Zip: Phone Zip: Phone:. FEE SIMPLE TITLEHOLDER: _ 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 permjt to do the work and installation as indicated. -1 certify -that no work or installatiomhas' commenced prior to'the issuance of a -permit; --St. Lucie Counttyy 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 our Notice of Commencement. - nature of -owner/ 'Lesse€mphm Signature f 4Ttt £License Holder STATE OF FLORIDA STATE OF FLORIDA - __COUNIILO -COUNMOF i1 S Co The -forgoing instru was acknowledged b fore me . '^ The for o)ng instru was acknowledged before me yday.of J 20 this day.of c lt!,�t ._ 20j'S by this y It (Name of person ack ding) me of person acknowledging ) _ ( ign tur Notary c- tate of Florl a) (Signa re of Notary Public- Sta a of Florida) Personally Known Personally Kno Type,of Identification ,:a ^� :, KABEN SCMALLl0f0— Florlaa Type of ldentific jgr;`,S.""'q Kl1HEN SCHALLMO Produced I ='';• Notary Puelk� -State of produced '� = Notary Public - StateLf� rida...omfi. Eyplres Sep 14. 2019 ;• .� . • om t xp res SaCommission No. ' �,.atA`r _ Cpcmm sbn�N F�F 149186 Commission No. � M 17hrIoull�o�eaaNa REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW - REVIEW DATE RECEIVED DATE COMPLETED ev.