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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION. I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPT-�i� Date: SCANNED Permit Number: BY f4- St. Luce Coul�iy�(ia�"I ` ' RECH, Building Pe rmft Application Planning and Development Services OCT 4 209� Building and Code Regulation Division - - , PER&I Il ' 2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie cc;L.+k,., . Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ReSidential Legal Description: Property Tax ID 4: Site Plan Name: _ Project Name: Setbacks Front Total Sq. Ft of Cost of Consti - 8OA-1 17_%J-71! - II I -A. A 2 AAA - Back: Right Side: Left Side: /i-orniAc.—?\ n,3 Lot No. Block No. _Gas Piping _Shutters V Windows/Doors _ Sprinklers _ Generator v Roof Pitch b1s.f. Sq. Ft. of First Floor: L-ACO9 Ys9, �-;2-91 Utilities: Sewer _Septic Building Height: j 2 }WNER/yLESSEE. _'q&. Name Z-C -0 00.r A ',Name M Address: � � 5 'Co R (-2 5 2. 2E Company �+ 2az S r^ ^� ✓ 1iS0 GIGleS City-. c \+iti eACl­ State Zip Code: 3J 4 0 to Fax: 6 tO Phone No. 5(C> Address: L7 AS __ CLC�- C>'\ Z& City: State: L Zip Code: 3y s Fax: Phone No 7 703 L E-Mail: ��� Q X Q� CkO CoM Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail Wee VS c-r-M S y iV10. COIN State or County License Gb C_ O S a 10 3 S If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. r t•' yyt�'pw {��.q. p�� a` +m: RA ., sew v k3riiQ4iiih.=q.S ph n.. ,yam j t '+ . DESIGNE3tENGINEER: _ Name: 1 oh r, to , F©5 Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: 11205 Re ��. Address: City: F; a r e a Zip: `1 Phone-m0l State: 4- 370 ctL4(oL4 City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: .ac , LC-.. x Not Applicable L,LG RW BONDING COMPANY: Name: _Not Applicable Address: 9_:�,24 IS. C. nacgk< Ajr-E Address: City: O. tr City: Zip: O(o Phone: Sto 1 y1 040 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 improvemen to your property. A Notice of Commencement must be recorded and posted on the jobsite before t e fi st inspection. If you intend to obtain financing; consult with lender -or an attorney before com n I Work or recordine vour Notice of Commencement. A re of as Agent for Owner • ;I Sigbature of STATE OF FLOR //�� ; :. r STATE,OF FLO�fM COUNTY OF /YI F�PQGi 1 CUl1hITY!OF The fo oing instr me was acknowledged before me The for oing instrument was acknowledged before me this T day of 4 J 20fL1 by this Tay of�r�J 201�' by Personally Known _�R Produced Identification Type of Identification (Sign ture of otary Public State of Florida ) Personally Known _V, OR Produced Identification Tyne of Identification A. ROBITAI n uLeu DANIELLEA• ROSITAILLE i1ON#GG01 51 '� / / "�'' C MISSION#OG0777 June.25,2021 Co mission Nob, �D '_wl qq�� p (FIRES: June 26, 2021 N'Pu*tl •2,g iy$.•' emd-WThN"PublkUndenM REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEATURTLEj MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW. REVIEW I REVIEW DATE U - RECEIVED b �, DATE COMPLETED