HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0L Permit Number: 0 V
®' ' - SCANNED
Building Permit Application BY
Planning and Development services St. Lucie Countv
Building and code Regulation Division
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 II
`PROPOSEd IMPROVEMENT LOCATION:
Address: IV-LD01 N U/U UiiXII'J ViiwWC
Legal Description: lcl - GY ]Ad(In - WIi- I -
Property Tax ID#:_ IVJ'lLD - LDUI- UUU'4�'UIU-'/,)
Site Plan Name: i7 , n �� /�
Project Name: F-t�/u. I Q'uy R lIT_I %- (. 1(�l.' ch
Setbacks Front 130 / Back: %s Right Side:00 LeftSide:
Lot No.
Block No.
i uC.tNILCu Lit �rmirI Ivry yr vyur(,p,: . k
_DaftChid nit-W OLLMSSOr f sty ��tre
LCONSTRUCTION INFORMATION: I
HoaaionaiworKCDDe
OHVAC
errormea
Gas Tank
unaerinispermit- cnecKau apply:
[]Gas Piping
_Shutters
Windows/Doors
11 Electric 0 Plumbing
Sprinklers
11 Generator
El Roof Roof pitch
Total Sq. Ft of Construction: 11'i'+
S Ft. of First Floor: )L
2
Cost of Construction:$ 1-U-J.00
Utilities:
SewerE]Septic
i
BuildingHeight:Ilk
1OWNER/IISSEE
....
CONTR,`ACTOR - -
_
Name 1 R( ,Q LS '
Name:
n
Address:
Company: O
City: Foi+ V 1 ex M State: iL
Zip Code: 30L- 0 Fax:
Phone No. �Z'32)' I'7NFan7
Address: 5 CDI -I VJ
City:Ul State: A
Zip Code: 3a003r] Fax:? O'J50b2-01n66
Phone No. SGO - Uq O - 49-U2,
E-mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: fi fU I Mt M(
State or County License:LF'P'V?��
11 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ) ( 11 �/ II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: T*&tpl (10PA IbQ hTQ0 Name:
Address_LiOEi �pou L Address:
City: 111f1 State: t 1, City: State:
Zip:9E_q'20 Phone: 3(bLn-'13W- %44 4 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 Countyy 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 vour Notice of Commencement.
STATE OF F �IW STATE OF F r
.per
COUNTY OF 24 Kyt COUNTY OF
Th oing in s ackno ledged before me
thi day of 20 t1by
(Name
of person acknorn
9L.'W•.
(Signature of NotaryPut
'ut
Personally Known v
Type of Identification Pr(
Commission No.2Wd
Revised 07/15/2014
OR Produced Identification
FELICIA TOLBMI
Public, North Carolina
My Commission Expires
March 03, 2019
The for oing instru nt was acknowledged before me
thisday of 20f nby
AAANAA
� c
IV
(N a of person acknowledging)
(Signature of No May Publjc- State offleride•)
Personally Known ✓/ OR Produced Identification
Type of Identification Produced
Commission No.2/�Lce� r' zle-6
FELICIA TOLBERT
Surry County
My Commission Expires
March na 9n19
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
N
INITIALS
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: Brhtol main'C
M 0
Name:
_
Address:(n175 VJ t-I
t %ppuP,
Address:
City: WI-Anfl
State: VL
City:
State:
Zip:'ZA Phone: nLo-93W-
t444,
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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 Count 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 recordine vour Notice of Commencement.
X
Signature of Owner/Lessee/Contractor as Agent for Own r
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
1
(Name of person acknowledging)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
5
STATE OF FF�HR��U i�K�i COUNTY OF ,
The for oing instru nt was acknowledged before me
this day of 20 L7 by
6 c
-mo
(9Or41JdPin'0?M2&
person acknowledging)
(Signature of No ary Pub ic- State offlerida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal) Commission No.W I5I Ztet
FELICIATOLBERT
Surry County
Re r s-e-d_0-7./15/2014 ---- - My -Commission -Expires.-
-------------------
March 03, 2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
I( 1(
INITIALS