HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: 2 Permit Number: y1o5-� 1,1
}� RECEIV7D MAY 23 2017
SCANIYEb
BY
Building Permit Application St.LucieCnnnt,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Aven ue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax' (772)462-1S78 Commercial Residential
PERMIT APPLICATION FOR: eys
Address: Ave -
Legal Description:
Property Tax IDtt: 1925'IIl 0001- 000- $ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
airionai worK to De perrormea unoer cnis pennu-aleLR an urdL apply.
_Mechanical _ Gas Tank /Gas Piping _Shutters
_ Electric
Plumbing
_ Sprinklers
_ Generator
Total Sq. Ft of Construction:
Sq.
Ft. of First Floor.
Cost of Construction: $
5W. QQ
Utilities:
Sewer _Septic
Windows/Doors
Roof
Building Height
Name_ _ L l e- a
Address: 300 _ dn' ��� d
Name: C4rt'S
Company:
City: ��. Q°Yrr�eI� State: fJ
Zip Code:: 3'2 S $ /i Fax:
Address: / 761 37
City: 42' /fit -Lc, Stater
PhoneN/1 777J�,"G= %JrJ�3
Zip Code: ?ti5�t-7 Fax:
E-Mail
Fill in fee simple Title Holder on next page ( if different
Phone;Nc{ 777� 802-3073 _
E-Mail
q..
State,or County License 2-Z07 b
from the Owner'listed above)
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
RECElY7D MAY 2 3 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 0rginio Aven ue, Fort Pierce FL 34992 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercialy Residential
PERM fT APPL)CATION FOR:
tS ,a�n�nc n� /IP_a SC�er or —
Address: 902I Obe�,,d.cr— Ave- •
Legal Description:
Property Tax IDtt: 0001- D00- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ fla• Oa
P=II I IIL - L1 ICU
Aas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: '—Sewer _Septic
Windows/Doors
Roof
Building Height:
-_-
_ =
— --
Name
k .e5 . ckS /4, y
Name: Cr? S Ja t.^SV"
Address:
307) Olen -dtc- Q/e _
Company: �4i3'o�Zc— ',a Sai
City: F-1.
Zip Code:
Phone No/77
State: f7j
3h5 $'Z Fax:
Z-) S 2� �5 67
Address: / 70 1 37 <4
City: 6L' /fie—c-r— Stater
Zip Code: 3`15 4-7 Fax:
,Phone,Nc( 77Za Z61-36-75
E-Mail:
Fill in fee simple Title Holder on next page ( if different 4
from the Owner listed above)
E-Mail
StWe_or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
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
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Agent/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ 6�t. Luc•NP, COUNTY OF - S • �.y<<Q
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
thi_D � day of V%a�, 20� by this dayof TN2tt>} 20_q by
C N't-\ Aso*\C%%r "\ah,nSc'ry�
(Name of person acknowledging) (Name of person acknowledging)
of Notary PubW State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced 1-
Nol'Un
12
MS6202Commission
;0SI 4,''�"i7br
to_S:De em
otar/PubG
Nd
REVIEWS
FRONT
ZONING
SUPERVISOR
I
COUNTER
REVIEW
REVIEW
(Signature of of Notary Pub7o- State f Florida )
Personally Known
OR Produced Identification
Type of Identificati
J
Produced
DEANNAMARIE GNEN�
I#GG
BMNAMA
022023
'Commission
EXPIRES: December 16, 2020
No.
�ded rnm Not jeAc undem rilor
PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE