HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM. 1
ALL L APPLICABLE INFO MUST B, COMPLETED FOR APPLICATION TO BE eCCEPNumber:
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St. Lucie County RECEN ED
Building Permit Application NOV 14
Planning and Development Services 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:-• g(oCO 5 OCe0Lr)7J)rjye- UrlIt 1405 t
Legal Description: -, pprS:2S � 1 (�j f110� M t t n s -F 14-05
PropertyTaxlD#: 4-502--(0?J - 0101-ir-cco-Co Lot No.
Site Plan Name: -Tb (-- 1-rY1TM--3S ("QQdQ Block No.
Project Name: OM�41 or R1ff Q(F'0Q'e
Setbacks Front Back: Right Side; Left Side:
pemovLe o.y-Ld Irepvace (z) lion-ImpaC4- Single-HUng
wiRCA8w3 t (z) Non -IVY pac+ 51 din Glass dogs, CU5+0MeF
has exi s-ring s>ii,)4-+e Ys . Permi�ul70B-0503
RUUILIUIICI WUI R LU UC CI IUI II ICU UIIUCI L1114 PC[ II IIL-L.IICL K Oil dliply,
0HVAC Gas Tank E]GasPiping _Shutters I A I Windows/Doors
11 Electric 0 Plumbing []Sprinklers 1-1 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.. of First Floor:
Cost of Construction:$ 1Q.C�M Utilities: 0Sewer 0 Septic Building Height:
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Name: f(I IC1P(QC�e
Address: qkM Q('EXDnDY 11Y11 1q 5
Company:-.�jhc Glaa<�, RreAcs5)on(a I S
City: f-n-,(--Y) a ah State: FL
Zip Code: 2�4q5-1 Fax:140r
Phone No. -7i2-
Address. 55-70 SF 1)IXIC -ijQ[\l
City G-" (fir State.. -EL
ZIpCode; 5i gcl-7 Fax: 28(0-04(oI
Phone No. -772 - ZS3 Q -Qq�5q
E-Mail; IV L4
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: p2n-n i-ts • QI6-,-,jrDYOS cQ (7 o) L lC
State or County License: 19 3103
If value of construction Is $2500 or more a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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 inspeC�tQn. If you intend to obtain financing, consult with lender or an attorney before
...I, . A...d:......, , Alntiro of r nmmonrwmwnt.
Signatur f O rner/ Lessee/Contractor as Agent for Owner
Signa a of Contractor/License Holder
STATE OF FLORIDA
C�V �I i�
STATE OF FLORIDA
COUNTY OF a r 1 p
COUNTY OF i�I
The fqr ing instr ment was acknowledged before me
this 1 day of j �1 A �� 20 )! by
The forgping instrument was acl nowledged before me
this ISTday of 20 I� by
U.0
to
I CAI
Name of perso aking statement
Name of perso making statement
Personally Known V OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
1nn/�
d o � 7'() lKA r R/�
(Signature of No Public State of Florida)
(Signature of Notar P blic• State of Flofida )
Commission No. R.•• KELI('Seal)MAN
Commissi NQ,•••ea',,._.� tcFLLY WIDIVI al)
Notary Public - State of Florida
ca' `o's Notary Public - State of Florida
`_• ; ; • Commission # FF 929255
- ; • Commission # FF 929255
REVIEWS
S
Natic
allR
PLANS
nd
it a L.,
GROVE
E IE
EVIEIN
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
17
DATE
COMPLETED
Rev. 8/2/17