HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 SCANNED Permit Number: / 170
BY
St. Lucie County RECZ,—WED
Building Permit Application SEP I - 2017
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 Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMENT LOCATION:
1�7 4,:�( -ee - Ctl
nK ylegcc
Address:- q
Legal Description: '7 '52-61 -0021
Property Tax I D #: 000-i Lot No.
Site Plan Name: Block No.
ProjectName:
Setbacks Front Back: _ Right Side: _ Left Side:
I DETAILED DESCRIPTION OF WORK: III
VC_50,c-� -tutu'-] -S Ile-e't 0,7c_Aoc�
Tire e
CONSTRUCTION INFORMATION'
HVAC Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ _W
Piping
Sprinklers
S'hutters Windows/Doors
Generator E] Roof
5 Ft of First Floor:
Utilities'll Sewer []Septic
Roof pitch
BuildingHeight: 14
OWNERAESSEE:
CONTRACTOR:
Nameo4e�z*� lb
go
Lks
((f
Name: L-0 �
Address: -7CZ5;C> _5�cL>
Company: �W lit elic
City: 74-Lo(
Zip Code: -3'-/ Fax:
Phone No.
—State:
Address: 1:56
2P
City
Zip Code: Fax:
Phone No. 772 2,�9 //
State: JL�
��IWca6l*7
9-3 �;'e
E-Mail:- 70-1-A &, enl 23 c.)j Id / V_g,s.
Fill In fee simple Title Holder on next page rif different
from the Owner listed above)
E-Mail: k1
q) e&c-y-
.10
State or County License: 4:f 13(f �2'5�5_3P,9:p
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
T�
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:'
DESIGN ER/ENGI NEER: Not Applicable
Name: (&ia IA.)C-
MORTGAGE COMPANY:
Name:
Not Applicable
Address: 2 uk5-
Address:
City: 1, 0'fl� State:
Zip: Phonej�-2 4 -CD
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
—Not Applicable
Address:
Address:
City:
City:
Zip: Phone:—
Zip: Phone:
OWNER/ CONTRACTOR AFFICIVIT: 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.
Lessee/Contractor as Agent for Ew—ner
��ignature of contractor/License Holder
STATE OF FLORIDA
COUNTY OF 5--'7- L arle
STATE OF FLORIDA
COUNTY OF 5T Lacte
The forgoing instrur�pnt was a knowledged before me
If is 20J
this day of )'I bC'b 57X by
The forgoing instrument was acknowledged before me
this 3 f day of A v�p& S� 2 6—LAy
�3
CY70-410-, &q'y_W-
CYA-fff� Sfi'roz_
Name of person making statement
Name of perso�naking statement
Personally Known v'— OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced-
Produced
opg�� '6kim-1
Ccj
:��, 60
C
(Signature'of Notary Public- State of Florida
rF2 %
(SignatureVof Notary Public- S atial
FF,� CYNTHIABAKER
N FF231910
Commission No. 3 (GI (GNKTHIA BAKER
MYCO1,MSSION 0 FF231810
MIRES: J.e 29,2019
commission No. My(
_=SION
J=c 29, 2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
91-5-17
RECEIVED
DATE
COMPLETED
Rev. 8/2/17