HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE INFP MUST BE COMPLETED FOR APPL',ICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
Planning and Code
Regulation
Dices SCANNED
q
Building and Code Regulation Division u lij'�\IJI
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial iO Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: III
Address: R2_115 S. (A Hiohl on I Par+ fit. W('aP_ R S4US?
Property Tax ID #: 3A 14 —501—
Site Plan Name*
Project Name: 4` a C1
Setbacks Front Back:
CC) L FP,
Right Side: Left Side:
nt 10,11AN y AUCzSDIIw ISr
Lot No. 1
Block No.
I DETAILED DESCRIPTION OF WORK: I
• ra ' [r • I I , t I
G t�
CONSTRUCTION INFORMATION: III
riuwuundr worn w ue enunneu unuer uus perrn¢—a
11HVAC 0 Gas Tank ❑Gas Piping
Electric 0 Plumbing []Sprinklers
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
Total Sq. Ft of Constructio�n:S Ft. of First Floor: _
Cost of Construction: $ I L l AJ. ( Utilities: Sewer E Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name U P. t i
Name: MIJn1'nvo, .3. INQAdJiC.0
Address:?YY1a nFoSh Ct•
Company: If)fI0VOrFi0Q Cy1-i�(f� QC*indlf 1C'r .
City: '(i oNpif10_ State: Ny
Zip Code: I �5(O 3 Fax:
Phone No. 51LP -&R-1-tntoo Q
Address: P.O. JS9X� I2-Irj-llrj-
City: F0Y + ps uct State: FL.
Zip Code: ,14q-1q Fax: nl I Pt
Phone No. -I1a- Vi lQ-g I OS
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ryltllal rnn �, i nnouQ+inneon+rQC+(ro _
state or County License: '�C�C15lIG l0
If value of construction is $2500 or more,) RECORDED
♦r
of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
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 yec;?bn.rlf
failure to Record a Notice of Commencement may result in your paying twice for
improveme rty. A Notice of Commencement must b orded a ed on the jobsite
before the r in you intend to obtain financing, consul lender or an a rney before
ommen n worn our N-oticeof Commencement.
i ature of essee o or as Agent for Owner
re o ntra for/License Holder
F FL R�IDA
54—
C UNTY>FLOR10A
1 r�
—��L
CLINTY
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thislLPbay of 001& 1her .20_n by
this10"ttday of NOV6_MbP f , 20JI by
Mieruael J. (1�01dron
jVlirmn0 �.I. nddroo
Name of person making statement
Name of pers n making statement I
Personally Known is OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced offa
��q
f i Y! l 5aa 8LQQ
(Signature of Notary Public- State of
Signature
of Notary Public- State of Florida
)
AMANDA ROE
:i° �4State of Florida-
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GG 746214
"" AMANDA RO
-State of Florida
Commission No.I�o214
No.C-t 141a214
Commission
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?• Commission #
My Commiss
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;A ingi
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REVIEWS
FRONT
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VEGETATION
SEATURTLE
SUPERVISOR
PLANS
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
4
Rev.8/2/17
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