HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM
All APPLICABLE INFO MUST BE COlvf ETED FOR APPLICATION TO BE ACCEPTED n yy��
Date: Permit Number: I1os' oRg-) 0
By
Building Permit Application Lucie ciI
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 fc�L_ Residential
PERMIT APPLICATION FOR:
E 3aS.i`•_'.�' N,k dr,I..y,
Address: 63-6d2 0%.&yAym.JS &JAIr ?ntZr e)r. Lucie FL. .3114gd
Legal Description: disrrn-nci A Pe v,
PropertyTaxlD#: 5el-eir o&O3S Lot No. —RIh3c-t
Site Plan Name: J06-II Til'.e PII Block No.
Project Name: JISTA,t/.4- 2464-
Setbacks Front Back: Right Side: Left Side:
_Mechanical
Electric
Gas Tank
_ Plumbing
permit - cnecK a
_ Gas Piping
_ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ % ('4 y
appy:
_ Shutters
_ Generator
Sq. Ft. of First Floor:
.1.111111111111111111ilikN ME
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
@ 07N M F W& 11OR:
Name dlcLj&mr Ass. 1A.J
Name: �Z�r G��u
tv4.MS
Address: 4'ao2 5w.y rfAvey Ci
Company: e0E.JoJ
t�k
-City: _Fh 2LA.y Or, State: L
Zip Code: 32Z 14 Fax:
Phone No. �%9) 1119- 1104e4
Address: 5151 A).
6*,g %7e_4A -o AJt
City: 101>f VI+AJ ✓.OQLIL S State:
Zip Code: o0a6 Fax:(-;i96 4bfi-4S6'.;L-
Phone No at, G- ,:)I - 2t'f4
E-Mail: RULt. c3ae■Wt .ti.apJ @0 ✓rerA& A. ta+v"\
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail /2c.4,¢e e@?awlo
i t.a • (Zo�N
State or County License
r [ G iT 22AccD
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:
AddressEj�ItAW4l
Address:
City: �olA State:
Zip: ..., a 1 FBne
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,oean`attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OFReRIDAX ��azDlv�nl✓�
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this_ day of . 20_ by
(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 Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE"
MANGROVE
'COUNTER
REVIEW-''
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
TE
CEIVED
TE
E
MPLETED
Kev. i/tuiv
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 Couniv 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
commencingwork or recordin our Notice of Commencement.
ev.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
�tY�
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature o Contractor/LicensF a H� �
STATE OF FLORIDA . - - •
STATE OF fk6RtBlt ��'"'�"E
COUNTY OF
COUNTY OF M 0.X i an '
The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
this —day of 20_ by
this �n'dayof�U�S�-20� by
T3re�k W � ll1 o.,nvs
(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 I��itftiAPiC
Type of Identification
Type of Identification �`,��;.\onco�'••,F'��
Produced
P