HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONMay 041711:05a p,2
ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 11 Permit Number: LZos-oa��
RECEIV'T MAY i o 20D SCANNED
Building Permit Application By
Planning and Development Services St. Lucie
Building and Code Regulation Division County
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 10 (ed 0 otijea
Legal Description:
Property Tax ID fl:
Lot No.
Site Plan Name: (' 2Q v, SD r 1 i Il i J ✓1/l Block No.
Project Name: �pyyl C
Setbacks Front Back: Right side: Left Side:
DETAILED DESCRIPTION OF WORK:
Co�1C'�ce Wo✓�L 1%ld----RepQrs or) Uyn),
�10f (el0/ i �L6? 10.3 t 2®-CI ZOq -+9O f AOflED
CONSTRUCTION INFORMATION:
lddlona wor to e e orme un ert spermi ec a appy:
EId1HVAC MGasTank ❑Gas
Piping _Shutters Windows/Doors
11 Electric 0 Plumbing 05prinklers ❑ EI
Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ %T l) 010 Utilities:llSewer EiSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i Name:
I
Address: U 2 l Company: Fl e i !0/n /
City: (1 An State L Address: n e /p
Zip Code: S% Fax:7o`I ^,V7n 19// City: ��f • ► C State: �
Phone No. 701 � _ / if g Zip Code: Fax: _7 l 1 1 ,� WO y
E-MaiI:Q/y/Q.�noo (��• y� . 1 a �I r 6d 7
Phone No
FIII In fee simple on next page ( if different E-Mail: r t l( 78
from the Owner listed above) State or County License: /': [�� /j' I of d
If value of wnsWction is $2500 or more, a RECORDED Notice of Commencement is required.
;27/6Oj—COUtYY
May 041711:08a p.3
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JUI`rLtlVlt:N I. -AL CON5TRUCfION LIEN LAW INFORMATION:
DESIGNER/EN INEER: _Not Applicable p MORTGAGE COMPANY: Not Applicable
Name: /%) h 4 H / I • Name:
Address: a-+! 3 x Address
City: S 1u a f State: C City: State:
Zip: 3 19 jti Phone: `7-7�L8Zip: one:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: -
Zip: Phone: Zip: hone:
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 anq applicable Home Owners Association rules, bylaws orand 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. �Iou intend to obtain financing, consult with lender or an attorney before
�s_•�. F u, ww11uir cesseerwmrac[or as Agent for Qwne
STATE OF FLORIDA `/ L
COUNTY OF !6, L a L
The forgoing Instrument was acknowledged before me
this ±Lday of_1220� 20 (Tby
STATE OF FLORIDA'
COUNTY OF_9���
The forgoing instrument was acknowledged before me
this,�LQdayof "/ 20 Zby
�—
(Na'Im�1eI of personayc�knowledging) (Name of perso acknowledging)
u /off l/alrjl Yf ..
(Signature of Notary Public-Stateof Florida) (signatu a of N ry Public -State of Florida )
PersonallyKnowny �M r�_ onallyKno Nttltitlt �yq ducedldentification_
Type of Identification Produ �"R�t Ty of Identl0t�eB`,�a_ r„.,,.,, i�
uvrmuursu ,
Commission
Revised 07/15/2014
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2018
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEONat
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS