HomeMy WebLinkAboutBUILDING PERMIT APPLICATION6�.
ALL APPLICABLE INFO MUST BE COMPLI l i FOR APPLICATION TO BE ACCEPTED Q
Date: Fi - 2 S- / Q[� SCANNED Permit Number:
r�= t� J. c'" •—� BY
St. Lucie County
Building Permit ApplicatioLMJ
Planning and Development ServicesBuilding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ! d
PERMIT APPLICATION FOR: p line 1 t hpJq �e
�RROPOSEI) IMPROVEMENT LOCATION:
dro box, click arrow at the end of �
Address:
Legal Description:
ah/1' Q,
Property Tax ID #:
3 S 2. Z - 6.0
- Jefocof
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
',`DETAILEDtESCRIPTION`OF WORK:
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CONSTRUCTIONINFORMATION
AUU I LW IIGI WUIR LU UC CI IUI II ICU UIIUV[ 1111D PCIfl ]n.—a
❑HVAC _ Gas Tank ❑Gas Piping
.Electric Plumbing ❑Sprint
Total Sq. Ft of Construction: 1,960
i
Cost of Construction: $ 2 S
L__-I Shutters
❑ Generator
S Ft. of First Floor: _
Utilities:ll Sewer ❑ Septic
❑ Windows/Doors
❑ Roof ❑ Roof pitch
Building Height: #oms
OWNER/LESSEE:,
CONTRACTOR:
-Name `?vnK n - - / N' — - 11f%
N
611r 0
Address: 111 Ade&A CrescAt
Compan l
un' SoYy
City: R, P, B. I State: FL
Zip Code: 3 � � Y Fax:
Phone No. 5.11 Doi - //9 /
Address: / t'ra
CY2Sce -r
city: R Pille. F
Zip Code: 7 /
Phone No. ✓�(0
State:- LTT rr
Fax:
E-Mail: /-e e_M'e, COssi
Fill in fee simp a Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 2 e /,e ZCA tee, 6oH1
State or County License: Fc / 3
II If value ofco construction $250 0or mope, a RECORDED JJotice of Commencement is required. II
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SUPPLEMENTAL CONSTRUCTI EN LAW INFORMATION: :.
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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
Signature of Contractor/License Holder
STATE OF FLObtIPA
STATE OF FLORIDA
COUNTY OF • L O e %-v
COUNTY OF
The forggoing instrument was acknowledg before me
b V
The forgoing instrument was acknowledged before me
this 2. day of 3DN 04 4 by
this _ day of . 20_ by
VC�t-%%ar.aa LteacqY��
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced V-L 1'� L.
Produced
GNENS
(Signature of Notary to of ON#�e G6 202o
... $
(Signature of Notary Public- State of Florida )
�f` 1RES:Decep
ag F°°r`urae�^ --
=Commission No. o
Bondedll� it
Commission No. (Seal)
;,I,o;�o„
REVIEWS
FRONT
ZONING
SUPERVISOR
PLA
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV W
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17