HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf ALL APPLICABLE INF MUST BE COMPLET I L t'DR APPLICATION TO BE ACCEPTED
Date: �� �� Permit Number:
• Building Permit Applicatio FEB 12 2o)s
Planning and Development Services
Building and Code Regulation Division sr AN^ S-- ST. Lucie County, Permitting
P
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 Sk a ,,,, 4Ne I III
PROPOSED IMPROVEMENT LOCATION: III
Address: i0 22.S S_ E Le nn �✓L 2 �(
Legal Description: S
Property Tax ID#: -3 //`r— S-ai— «zo /-0-,O-z
Lot
Site Plan Name: Block No.
Project Name: /-Lo -r i✓ a r c n
Setbacks Front Back: Right Side: Left Side: II
DETAILED DESCRIPTION OF WORK:
Zi!sl�t/ L e.11-7 r3.»c s'sn
Y�idi it,
SCANNED
BY
St. Lucie County
CONSTRUCTION INFORMATION:
C - • it
itiona wor to e e orme under
C11 Gas Tank
tispermit-c ec
Gas'Pipin
❑g
a
apply:
Shutters rsI
❑Windows/Doors
Electric El Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction: 3 2-
L
Sq� FFtt.I of First Floor:
Cost of Construction: $ �/'P 0
Utilities: I,
(Sewer Septic
Building Height:
OWN EF /LESSEE:
CONTRACTOR:
Name
Name:-'
Company: -Sl G N
Address: 0 _"
CO
Y -LLTnnc�/o iz_.p
Address:I D22. tr 5 SL-EM N A-R0 120 (�
City: L - State: l �-
PS
Zip Code: 34ct s?- Fax: -712-2-3'1-g- —N
Phone No. '112--1 Y1— Q 33 S
City: lo+ f t- s +- L. < State: %�
Zip Code: 3 cl 9 S Z Fax: 3 3 7-Casco
Phone No. 33 S- Z Y-t /
E-Mail: t4VT_W0-t-Z7 k_( ®GMA-L, OM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: S 1 cS" euv%
r u -,n� VNSL- Q
State or County License: N"` I �o ~
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
LAW INFORMATION:
Name:_�H
Address.. 9" 5
City: ��� < t t rc• e F"L ��a.�: F
Zip: 7't 9 rry Phone 7 trs=y ems'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: k-c-c-
M
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
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 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 Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID,
COUNTY OF l a lC I Pi
The for8oing instrument was acknowledged before me
this "I day of 1=eC1 .20 -& by
tdyvard Lrud-erbac(_
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public -State of Florida I
Commission No.tJt+ I `l % Public State
of
pladaKristine LLoudeftck
;t
My C=mIsWw 00108910
REVIEWS I FRONT I ZONING
COUNTER REVIEW
RECEIVED
Rev.8/2/17
Signature of Contractor/License Holder
STATE OF FLORIDl�
COUNTY OF Si 1- IA CA
The for oing instrumen was acknowledge before me
this 7dayof 20 by
61Axtrd I ot,«1cyha--ck
Name of perss n making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
'�AA,IClAiM( CX ��'/OViO�I�t-��CC
(Signature of Notary Public- State of Florida )
No6c, (09R'(O
SUPERVISOR
I PLANS REVIEWA VREVIEWON I S REVIEW