HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.z
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
c� !�
Date: �3 '�� SCANNED Permit Number. Not - P asa
BY
i tr `=" " " p St. Lucie County
N.0
210 Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P.RC+POSED IMPROVEMEN�Tr LOCATION: -
\
Address: `�j 857 �o-SI_ S o wn f (- 1 14 . f l`e rc g 3149912
�p �
Legal Description: 1a. Grrnlia Ifon,:16 -.5d:4,v-nel•e ZQ(a•- aa,:7yyz)
q
Property Tax IDN:_34f(D-�D7L' -t0oI—oo-I Lot No. /t'I_
Site Plan Name: Carp0A -er Fa.?r-IU4hi51-s Block No.
Project Name: l ea,r
Setbacks Front — Back: Right Side: Left Side:
�efno✓2 G1G,S f+ Gt�c� /`e7olace wi 1�+ Wwll� l� fJcJ�. w��(pc �ri c.
/Ivr 41.L L,1XCt & W4T4ti -HI�6T261,
CONSTRUGTION:'INFORMATIQNa.
rtiona work to be nertormed under tispermit-check all apply:
1 Gas Tank ❑Gas Piping Shutters ❑ Windows/Doors
�HVAC [ _
IJElectric EX-lumbing Sprinklers Generator Roof Roof
- pitch
Total Sq. Ft of Construction: Sc Ft. of First Floor: )4`7
Cost of Construction:a�� 96 Utilities: Sewer Septic Building Height:
Ln�
'OWNER%LESSEE:_ `~. CONTRACTOR: r
Name
Name: CrJm
Address: S\S'(
Company: f-� it loon, J<s
City: F+. N t P_M 2 State: _J
Address: ('7 Lk) 1414-A,0C
City: DC.. o_ Stater
Zip Code: Jqq R2 Fax:
Phone No.
Zip Code: _:�q Ll `71E;_ Fax:
E-Mail:
//
Phone No. 3 - - e 02 ISI-art
Fill in fee simple Title Holder on next page ( if different
E-Mail: _Karc,nc�t
; r ix .ksconS I r��: an .Cam
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
INFORMATION
MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: ✓Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Address:
Zip:
Applicable
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 an covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions wh ch may apply. RECEIV
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. APR 2 O
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-residentialnitting Dep
t. Lucie Cc
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
commencing work or recording vour.Notice of Comrencement.
Signature or r Lessee/C tracto�ras Age`nfor Owner
of Contractor/License Holder
Sign ?Ir
STATE OF FLORIDA
STATE OF FLORIDA.
COUNTY OF Awow
COUNTY OF �M"sW
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 3 dayof SA7J 201-9by
this day of '-CMww 20/Jr by
Name (person making' statement
N erson making statement
ersonall K wn OR Produced Identification
ersonall Kn OR Produced Identification
Type of (den I (cation
I ype of Identification
Produced-
Produced
Ignature of Notary Publi - to of Florida }
—(Signature-of Notary Public- to of Florida I
RICHARD LRAGLE
tlkyApse' RICRARDLRAGLE
y�js@ip.kilsSIGN#GG
Commission No.� _$��,���' , LIMISSION#GG 059MI
Commission No.. : i 059M
a EXPMES:Janary21,2021
'For'LO' Bonded TRv Budget NotmySenices
EXPIRES: January21,2021
9tfL DbA99EThm Notary seM
Budget
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17