HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLI113LE 11100 MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: I 1/ 11 Permit Number: C )
SCANNED
BY
St. Lucie County
�
Building Permit Application
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 i/ Residential
PERMIT APPLICATION FOR:
W
Address: oL SU a UJ� Aye. PcerC P F— 9 wo k ' IL
� oq ufrN /7%1- /WC, FP 3 VIV6
Legal Description: _ ..
In 1_
Property Tax ID #: Lot No.
Site Plan Name: Block No:
Project Name: cS%1PfQfiUY� P j0.2A
Setbacks Front Back: Right Side: Left Side:
RXIIIIIIIII
a
MEMIM
Additiona wor to' eperformed under tispermit-check a 't atappy:
_Mechanical _Gas Tank Gas Piping Shutters . Windows/Doors
_Electric Plumbing _Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq.. Ft.,of First Floor:
Cost of Construction: $ DO Utilities: _Sewer —septic Building Height:.
Name 5k P—( Name: DTY) d Wf_r-1--
Address:o Vi • 1 l 62 Company- gec rea4i,q-n Str AC S c
City:, O1- (er State: L. Address:25-02NiA) % H,, *ate
Zip Codex32g0'a Pax: City:.Wr� State: fL
Phone No. i _ Zip Code: Fax: _9jl -1f77- 131.3
E-Mail Phone No 6Z0 1 919'-grO
Fill In fee simple Title Holder on next page (if differe E-Mail jyJ 2:S-)�- CO-n
from the Owner listed above) nhi License. r&ci520?ac% __
If value of construction is 2SOO ar.more, a RECORDED Notice of Commencementis required.
5 PPL ME S0 STR
10
A
MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY: IzNot Applicable
Name:
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 (
which is it
structure.
covenants tnat may restrict c
tr any restrictions which may
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
commencinE work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor ffAgent for Owner
Signature of Contractor/License Holder
STATE OF FLORI p
STATE OF FLORIDA
�pp
COUNTY OF _ d k
COUNTY OF eilrn bt'dch
The forgpIng instrument w,'ggs acknowledged before me
The forgoing instrument was acknowledged before me
this3,,nddayof IVIa c 2017 by
this_- dayof etcerr,ber 201& by
isnrL SA
r pn
nnald LA�V—
(Name of person acknowledging)
(Name of person acknowledging)
KEISHA HOTALING
WWtiti r r l-t�
�101�1�"10.ty + NOTARY PUBLIC
Sig ture of Notary Public- State of FI tda)
(Signature of Notary rublicR f tBWT� OF FLORIDA
/ �Comm#FF021704
Personally Known �' -�'�'
Personally Known ✓ O . ce0"@j9W2Dj
Typeof Identificatio. ytis::tys JOANN M.RILEY
Type of Identification
Produced ; :Commission IfGG054939
Produced
f
F�p1res December 13, 2020
Commission No. G �Si0e07huiy eoaassasts
Commission No. (Seal)
REVIEWS--
-FRONT-
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REYIEYV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
1
DATE
COMPLETED
Kev. r/ZU14 1 7 ,/