HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 11 V t9 7 U
Building Permit Application Alunoo aionj )S
Planning and Development Services Q3N 9
Building and Code Regulation Division
VOS
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 2C Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: 9702 C'Kda,-.atowt5 tJwg '7oQT 5t•. Lve%E FL. '%NOAfe
Legal Description: VI6Tu mbk -P&A RESORT
Property Tax ID #: Fi 9- U� 0(O ,?vS Lot No.19 -kS `I
Site Plan Name: &yA u A A* Tr%,.;tT Block No.
Project Name: JiaiNhrN %A jersowr-
Setbacks Front Back: Right Side: Left Side:
J"DETAILED DESCRIPTION OF WORK''"'
-REPLAfllr6 /O . UNtT LtJT2V DOORS^'�SLntB oNLy), ALL evi-STW& Fev%mrS t SKrV&J,4�
to REr%aitil THE S"�'''�ti'ia��+t:'ti..-. ,Z)
0HVAC UJ Gas Tank ❑Gas Piping
11Electric 0Plumbing ❑Sprint
Total Sq. Ft of Construction:
Cost of Construction: $
iie
Shutters O Windows/Doors
Generator 0— Roof = Roof pitch
SQ �Ft. of First Floor: _
Utilities: LlSewer DSeptic
Building Height:
DOWNER/LESSEE: "'
CONTRACTOR:' n w
NameJILLAcs A%c.T* drn,uaewawIa. t Ass0cjAT16^) /NC
Name:
Address: gobs 5..,,.a r"I,aaco er
City: ORLAMDo State:_L
Zip Code:-3A8'I9 Fax:
Phone No.'
o. �L/oa) YIe - -iLnq
Company: y-rmoo IV.
Address: 6t51 ,�) se,%ytL mto Age,
City: Irdo10,NAV0Lub State:zA1
Zip Code: H62aG Fax:(314) 946- 46'c 9
Phone No. f5t& - W41 - a 1 Li-4-
E-Mail: t3a�.7SrtEi 1wfEnt,� V eO�ItST.ww. CO.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: YPwmt? @ 12ENeJ %b. Clow
State or County License: CG?C I57zzwO
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION':
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/Lessee/.Contractor,as,Agent fonOwner•
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
STATE.OF- MMH)Pt I NATO WA
COUNTY OF I ox ion
The forgoing instrument was acknowledged before me
this,�dayof AtAt 20 Eby
1 11�e-k & MsQee
(Name of person acknowledging) (Names of
pers '
n�acknowle�dgyiinng )
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
Personally Known ✓ OR Pro
Type of Identification Produced_
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
'MANGROVE
COUNTER -
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: /
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY. _ Not Applicable
Name:
Address:
City: State:
Zip' Phone'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 grand 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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
Signtractoi/uce� der�
STATE OF FLORIDA
STATE OF FtMtBAr
COUNTY OF
COUNTY OF M*- i on
The forgoing instrument was acknowledged before me
The forgoing instru ent s acknowledged before me
wa
this _ day of . 20_ by
S� 2011 by
this 25 'Nay of AW
13re-4+ W ) ll10- s
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced IttC
Type of Identification
Type of Identification �.���: •\o� co��•` F '/.�
Produced
Produced Jo <'.
Commission No. (Seal)
Commission No 60380 OTnRvseP�N;
0
REVIEWS—
FRONT
COUNTER
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE//o
�)r19 VC
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
KLM W
DATE
RECEIVED
DATE
COMPLETED
ev.