HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE
Date: _� 1 ` 1E
rED FOR APPLICATION TO BE ACCEPTED
Permit Number:
SCANNED
BY RECEIVE®
t.'Lucie County
Building Permit ApplicationAUG 2 1 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
V
Residential
PERMIT APPLICATION FOR:I�E,71Q2 K DUAl(f UIroS� OJcf�
Address:
Legal Description:
Property TaxID#: I J (p10-04747(� ODv�17, Lot No.
Site Plan Name:;ga f4l c VG at,) BD_ G �I L%tp Block No.
Project Name: ROJOCJC Dm2`j Q t CrLD' 6&
Setbacks Front Back: Right Side: Left Side:
lr%
Ian
_Mechanical _Gas Tank _Gas Piping _Shutters
0
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Gip. Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
ONUN€R/LESSEE:
CONTR CTOR:
r NameL tNbRr - W 205 (la5i
Name:
r-�
AddrePGA- -*1oo5
(
Company:•..C—A& 5 JVl'.. �e,'s•i� �:
ts-s:so,k.6'
City: 6cC y C ' ` State: f-L
Zip Code: 3A A� Fax: �Z - O
P60ne No: 'A'-9 5VI- 153
Address: 73oo 44, l/re„�r-�
City: ('off r� P State:_ C
Zip Code:'? 3 D / Fax:
Phone No j? 27 - -70'7 — 94,76
E-fvlail: r n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail b s yVt'« L,e Z/ (2 �F� ~�' . °n
a or County License C6 C O ( / Ci 1'i
If value of construction is 2500 or more, a RECORDED Notice of
is requirea.
R/Cs4�S/E�/ L°
SUPFLEIVIENTAL CONS ION Llf-N LAW IN'FORMATI-@
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 contlict 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
rnmmpnrine work or rpenrdine vour Notice of Commencement.
I
Q —
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE 01`+f:0RtE9!' N k'M0,O.UOk1nQ,
COUNTY OF �I•• LUCA
COUNTYOF t,1eW\AN"cUQli
The forgoing instrument was acknowledged before me
The for oing instrument was, acknowledged before me
this R day of 20� by
this day of kA5't . 20_LJ by
�.
s�CLvV6 A- aos;�n
(Name of person acknowledging)
(Na of person acknowledging)
N I
(Signature of otary Public- State of Florida)
ture. " Notary Public- State of-Fle�r'r�aj
Personally Kno i a ' n
Personally Known OR Produced Identification
Type of ]der tifi Up Notary Public ware rn Florida
Produced
Type of Identification
ProducedG\Q. OL
R\5__.
soFFa79335
Mry Casnom(
4R-; <5rOry j •,
S1
srzsanCommission N
Commission No. k�OTAR ypmNs
Z 12
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS'
VEGETATION
SEATURTf¢ j
.411NG\i3%�
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
""nnurun.`"'`
RECEIVED
DATE
COMPLETED
Rev.7/2014