HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•ABLE INFO MUST BE COMPL( FOR
Date: ' --I I30`Is
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
TO BE ACCEPTED
Permit Number: ) 56'1- (3LJ(0- 9
r
RECEWcD JUL 8 0 296
Building Permit Application
Commercial _ Residential
SCANNED
BY
St. Lucie County
PERMIT APPLICATION FOR: III
Address:_42ta&(o �(,*ON �-ffd-ela-( /TW y.
Legal Description: 341 / :5-, S01 — 00 b.5- _ 000 -
Property Tax ID #:
Site Plan Name: IK ;FM
I� TlRr1R Ggs(
Project Name:
Setbacks Front Back: Right Side:
I
S
IMM
Left Side:
r SCIo,7 — ln�d ))I/L-'c S' ,/'
r{amnondi warrc w ae Pet olmeu unuer Lnis [AllIIIdo uidL dppry:
✓Mechanical _ Gas Tank _ Gas Piping —Shutters
_Electric )/Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $ .500•
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Lot
Windows/Doors
Roof
Building Height:
Name n fit., �_—_ _
"Namechzsxe-fJl�fs'
Address: l �P SruooagA�
Company:-IL�"(k)s ((Cl�5 S- I&-�,ku
City: F a State:; T
Address: ''70l lJa Y1Alh'%ZD
City: 'T�-
Stater
Zip Code: Vq O- Fax: 77a - `Y'91
Phone No. 77,;X- IJY- 5F4 0
Zip Code: Fax: q6/-3p2yri
E-Mail: S621CVDS-VJ (R DD. CDn
Phone No. ?iZ��l9-O/L7
Fill in fee simple Title Holder on next page (if different
E-Mail: rn ar 1 r a (Z,vnl i, i(r�SQ> I
Fi �r�*+Lvu i-N
State or County License: CAL I �7(7
4 Q S°S
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not
Name:
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
MORTGAGE COMPANY: V Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
Zip: Phone:
Applicable
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, sighs, 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 vour Notice of Commencement.
Signature of owner/ Lessee
Signature of Contractor/License Holder
STATE OF FLORI A
STATE OF FLORUDA -
COUNTY OF L ,() t i�
COUNTY OF I l t, � f I.C.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this '!>C) day of `-'�, �,, , %,_ 20_�,&by
this day of � J\ 20� by
(N— a�of prson acknnowledging)
(Name of person acknowledging)
(Signature o tary)diblic-State of Florida)
(Signature of Noltiyy ubli State of Florida )
Personally Known OR Produced Identification
Personally Known —\,/— OR Produced Identification
Type of Identificati
Type of Identification Produced
� Ei ;, J. L BRIDGES
;gins%lye. J. L, BRIDGES
Commission No. �: :r Commssior{1i��3g731
Commission No ouss(on#EEj
F.. xpires September 13, 2016
��iy4", 9ad+a TW T�a7 Fab 1, a 8093BS7019
" = Expires September 13, 2016
BoMMllyu Tm)FaM
�1S•J`- Nsumae B0038&7019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
MeV.//LU14