HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMP«YED FOR APPLICATION TO BE ACCEPTED
SCANNED
Date: BY Permit Number:,��d` C)5q$
St. Lucie County
— REU i1/KC)
- _ Building Permit Application
Planning and Development Services OCT 26 ;.,, B
Building and Code Regulation Division �,. L_,Rte County, Pe^mkting
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
Address:
Legal Description:
Property Tax ID #: _39 Iq -501 - I404 - 23C➢ 3 Lot No.
Site Plan Name: 1� Block No.
Project Name: [�
Setbacks Front Back: Right Side: Left Side
ryyn. aT-s7��i t yn
DETAIL EDDESCRIPTIOIVOF,WORK i'x� z �p1'Y
minx rtisr �zN t,.a ,"ui a�.1 O a:da �xv e ±�
,+�'�x ��rS:fi,.�."s� �
CAfC[R naS-.
❑HVAC u Gas Tank
9Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2,00D.OD
as Piping
Sprinklers
L-1 Shutters
Generator
5 Ft. of First Floor: _
Utilities:ri Sewer ❑ Septic
11 Windows/Doors
❑ Roof = Roof pitch
Building Height:
OWNER LESSEE ` t, t ' `� '
a I z
+. • v .. ',Y+u v 1 ('. t .r. i a, lr.! x.1-4 a.43firt'..�i`e11},a.
'CONTRACTOR :a ti t r e
.t _ttt „. 1.i4a'• } ��]. ,. � � 4.}.s 4. e i �� r.
Name lik5tDtc1qeL
Name:, )Dhlrt P eAehl-e
Address: [,AVI MdAei
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Company: StY K-e CtYI CaA
City: ?AA f (&to State:"4
Zip Code: I4ZZ) Fax:
Phone No.
Address: yLzq St) NIOYI
PXJ()U)S&f
City: r
Zip Code:3
Phone No.7112-21CI-3Rq
State:
Fax: 112'71q- 23 42
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: �ll@ Sto
l(- elptty�i r,
Lok-o
State aunty License: EC13003of
^.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONJLIEN 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:
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 or an attorney before
commencing)mo5k or recording our Notice of Commencement.
Ilk
/ /FY' w
Signature Owner/ Lessee/Contractor as Agent for Owner
Sign ture ofFf Contractor/License Holder
STATE OF FLO_f
STATE OF FLORIDp
%,
COUNTY OF trIUV�) n
COUNTY OF�(�f 7111
The fo g�{g instr me t was acknowledgel?efore me
this a— yof ,20J by
The fo g instrument was acknowledge before me
this l d yof i)CA)O X 2011 by
JCIM P Mall e
JOhn P u it l-e .
Name of pers n making statement
Personally Known OR Produced Identification
Name of pe&n making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
PrqeWced
�
r
&ek
(Sign re of Notar ub - Sta f Florida)
1 ,I�$SICARBRYAN
fission No. :s"•'b•F pN�o SStONi160241369
. `. .:YPI�'' clobet t9,2022,3
_+: ;.
'+:aF ' Pu:.. UnCn^.:!te
(Signat of Nota
o ssion NO. MYCOMMI3JESW
a@'•: �16tlAIL
31Gz113ra
EXPIRES:OCfOber19,2022
'",,E,°�ti$••• Bond6d tl11110dIr P116BC llldBldljllf8
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17