HomeMy WebLinkAboutBUILDING PERMIT APPLICATION{b
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCABN1NED Permit Number:
St. Lucie County
.� Building Permit Application
Planning and Development Services
Building and Code Regulation Division 'we 1 1D17
2300 Virginia Avenue, Fort Pierce FL 34982 E RNIITTI
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentiafit Beare c� Nay F1,
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line=III ,PROPOSED.IMOROV.mz . LOCATION... `.
Address: 9 D S 4
Legal Description:
E
Property Tax ID #: 39act - 13'i - 001 - Off- S Lot No.
Site Plan Name: Block No.
Project Name: SA Luue— G'-JWA_ Church
Setbacks Front Back: Right Side: Left Side:
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CONSTfUCT10N�INFORIVIATION
Additional war to
IV
e ertormea un er t is permn- c ec a
apply:
❑
HVAC
Gas Tank ❑Gas Piping
_Shutters
Windows/Doors
Electric
� Plumbing ❑Sprinklers
E] Generator
Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ JG 0 Sih7
S Ft. of First Floor:
Utilities:lSewerOSeptic Building Height:_
SOWNEEt%LESSEE)GbNTRAGTOR
`..
Name 3)sbS�2 Q_E DioceseF.FI
Name: ; 7r' 3Fb.sc.c�cC�
Address: f� 8x !09r.-S0
CompanyA'csirrn
City: POJ, 3 c), (3urcl e"s State: FL
Zip Code: 334)o Fax: SIQ( -1115 g925
Phone No. SLet'115-aslL{
Address: I SSR Ct- Q) k5 v e
City:Fi 1.0,uder.cloJ e State:'L
Zip Code: 333 (A Fax: W& Gm - G3'7 Q
Phone No. G6l - a35. 5516
E-Mail: (y) I o UCW go d. R d•
I nou_ a , 17 (T
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: j errs 1)i.,g �cIkcp Coe,
jpP
State or County License:
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL;CONSTRUCTI�N'rLIEN 1,1MNFORMATIQN
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
commencina work or recording ur Notice of Commencement.
7 �
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sig at a of Contractor/1-ficerfse Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF a.6-" S2 cA
COUNTY OF gro w ar cJ
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 3Y-dayof &ftkr,< 20a by
this /) day of la 20_a by
Adr1ae.l LDtlrw"Vil.
Name of persoq aking statement
Name of persoy making statement
Known OR Produced Identification
Personally Known OR Produced Identification
Personally
Type of Identification
Type of Identification
Produced
Produced f •"""•—NADINE...... Si FIE C
• Neilry PuGic-Sate daoriy
{•(: i' �• C^.nnifsier BGG:43590
lZ ,6j M7 CenrthPim Nm7, lOn
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1CRR S,IASMY/ 4V M1 A W..
(S gn re of Notary Publi
ignature of Notary Public- State of Florida )
�A ;¢4 R CALITTO
Commission No.
'jComOGG054852
Is
ommission No. (Seal)
Expires March 31, 2021
REVIEWS
FRONT ----ZONING
-SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
/
DATE
COMPLETED
CT
Rev. 8/2/17