HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: O 1� / Permit Number. I 1 1(� Q-5I \'—s
o SCANNED
BY
Building Permit Application St. Lucie County
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Ay,r4WnA--4G
PROPOSED IMP„ROVEMENI LOCATION: "=
Address: _ •r� oc, 01 E%i�✓b y
Legal Description:
Property Tax ID #: S4- 1 v
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
I
CYoMMcar��L /4Tey,e;v L1041
Lot No.
Block No.
'CONSTRUCTIQN;INFORIVIATION:.
.
tiona wor
to a er
orme un
er t is permit- c ec a
apply:
E]HVAC
11GasTank
❑Gas
Piping
In _Shutters
Windows/Doors
11
Electric
0
Plumbing
Sprinklers
li Generator
1:1
Roof
=
Roof pitch
IITotal Sq. Ft of Construction: /n�
Cost of Construction: $ �.���t � • oo
S Ft. of First Floor: _
Utilities: Sewer[]Septic
Building Height:
`O,NlNER%L'E55EE
CONTRACTOR:
Name VIL-L.FEbE A6-
Name:
Address: gi3% o5, LC -2
Company:
Utii per
FauP�'w��'f�✓�
City: 'Pox;r- State: FL-
Zip Code: 3,{ 9S2 Fax: I -77--etr- o & f
Phone No. 7-7 2 - J $ - $U e
Address:
Soq W a�?- 17-
,A
City:
Zip Code:
Phone No.
3 3 o io Fax:
30.r 77d:' ✓'-513
State: %-e
304i3,Pu 00L
E-Mail: 0—K-PrtlEnd g? bf-4(-"Ok,�` 04!1�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)-
E-Mail: a a 0 CPO/ @
ohO a. co �7
State or Cou y Li ense: C,4e /dV/P;7-e2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
NGINEER: . _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Na
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City: City:
Zip: Phone: Zip:,
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 Count 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 trv' h)ender or an attorney before
cornmencing work or recording our Notice of Commencement.
Sigbhture of Owner essee/Contractor as Agent for Owner
Signat , Col ract r/License Holder
STATE OF FLORI
STATE OF FLORI DA
COUNTY OF 111GP ���� ��
COUNTY OF ItI�IP,
The f r oing inst ut was acknowled ed before me
this day ofmen, 20a by
The forgoing instrument was acknowledged before me
this Iq day of i%Alle4J 20AI by
Name of person making statement
me-e- f-perso aking katement
Personally Known OR Produced Identification
ersonally Knoj h OR Produced Identification
Type of Identification
Type of I entification
Produced - Ivty ICPytz,'Q,
Produced
L� 9GP/IYI;�__
�VW49 AEI '
Signature of Notary Public- Sta
.f` NICOLE M. MORENO
(Sig ature of Notary Public- State of Florida)
,,.•" ;"•• NICOLE M. MORENO
Commission No S �MMISSIONIiGG0T8Wim
c� ;} �Q OMMISSIGN 8 GG 07
mission No.(P]RES:March 28,202
w 28,•m2
{o
Borded71Yu W1ery PWk
6�n..I.EIXPIREES::�M.,arch
M_' Bx"IftNWa�y Pubic
REVIEWS
FRONT
ZONING
SUPERVISOR
—PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
F
Rev. 8/2/17