HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI gut -6—'1f3
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /Q j)
Date: ,L.L'! Permit Number: _ V w
tJ SCANNED
;__ BY
St. LuC( RECEIVED
11111111111110 Building Permif R(�i' wcation FEB 0 2 201 i
Planning and Development Services
Building and Code Regulation Division
5T, Lucia County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 ,/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line II
PROPOSED IMPROVEMENT LOCATION:
Address: gq(00 S. (30Mn-byive (,lnl-t 1Lp03
Legal Description: l yle_ ii i y-P Ynar 31 unit tbo5
Property Tax ID #: LI,50a - _70A -013L9R - OM- A Lot No.
Site Plan Name: -(hp- Ydl) rarY ay _ - Condo Block No.
ProjectName:-:p -IE�l6eriCe
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
-Remove O-r\d Replace SIfd(ng glass dabs (5)
CLt,s+om e v {gas exi si aq S h.utiters .
CONSTRUCTION INFORMATION:
itiona work o e e orme under t-checkispermit a apply:
0HVAC �GasTank ❑Gas Piping _Shutters "IEZWindows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 77, Co
S(11 -F-t,� of First Floor:
Litilities:nSewer Eheptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namer-iiee'ri u+chirisan`1Yy,+
Name: uid LapmCie
Company:-F('IP_ 0,1= SSfOr)CLIS
Address: 5%34
City: inl-edn State:
Zip Code: jk3t01* Fax: Kl 1%-
Phone No. 4101- a00- (o%7
Address: FORT SE -bi i e --" Wy
City: State:_L
Zip Code: Fax: -1-7 a-ae)6-OUia (
Phone No.-1'7a.•o_I9(o-C46Cl
E-Mail: 1n�pLQhPX,net
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: r) i i_-S . 91 r, _0ap ('iZ(R9,4M D a Q .
�Panr
State or County License: 1 q.P)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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
commencing -work or recording your Notice of Commencement.,�� _
Signet e o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Mox-b n
COUNTY OF m (jJ{ U ru
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20-Ja by
I
this _y day of 2018 by
Name of person nurkini statement
Name of person king statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
5�QQQpR2 ol,y
Produced
NoQ� ` 0;O'Lmat�
(Signature of tary
(Signature o
r ILCZ&atelkf 51100,42A
KELLY WIDMAN
Commission No. =+• +`�: Notary(AMM - State of Florida
Commission No
i•'n"r'o�a,,, KELLY WIDMAN
=:° `�: Not ry Public-(figgldf Florida
?' • . • Commission # FF 929255
=' • •= Commission # FF 929255
My Comm. Expires Oct 20, 2019
=j� My Comm. Expires Oct 20, 2019
OF i\ °a°•'�
y Assn.
SEA TURTLE
REVIEWS
FRONT
ZONING
SUPER IS R
PLANS
VEGETATION
MANGROVE
COUNTER
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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