HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll
Date:
�O MUST BE CJ....)LETED FOR APPLICATION TO BE ACCEPTED iQ �j
20 Cg Permit Number:' e [ O3_ ONO
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Address: N 33 S.
Legal Description:
SCANNED
BY
St. Lucie County
Building Permit Application
Commercial ✓ Residential
Property Tax ID #:
l `t ' 501
05- - ()5tDq
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors'
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ X f- uozi Utilities: —Sewer _Septic Building Height:
°GiWNERJLESSEE
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Named 57 LUCi-e DALE'► PLAZA LLe-
Name:
Address:
Company:
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City: `. r+ti:-:.- hc_. State:_
Zip Code: Fex:'y
City. ZS e-k.'C'
State:�L-
Phone No.
Zip Code:34,C=Ng C>
Phone No -I-TZ ^ 7=,-6,C'
Fax:
G7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail Ci �a a M�s_tata
c� _C�✓t4.�t✓
State or County License(2
j�, (
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT I� CONSTRUCTION L1EIV;LAW INFORMATI(3N r a
�, s.•
DESIGNER/ENGINEER: = Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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
is in
which 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 our Notice of Commencement.
Signature of Owner/ Le see/Con actor as Agent for Owner
Signature of.Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S-?Ra.
COUNTY OF
The forgoing instrum nt was acknowledged before me
The orgoing instryp�nt was acknowledged before me
this day of 20 1 by
this day of ' 9 t[incJ�_ 20_$by
1 U n n_ ., 0-,.o n w
- `�C✓t}�,,� rim+°:- .
(Name of perso cknowledgi g)
(Name o— f pe�rso aWnow ing )
(%Ditture of Notary Public- tat f Florida)
(Sigheuure of Notary Public- Statf.4 of Florida )
Personally Known ,2-- OR'Prddu(d+lde6tifiiegtior�
Type of Identificat' n * Pis;,, P�uuc - s ate e `
Personally Known OR Produced Identification.
Type of Identificatio ` t%s. lv
, Notary
Produced '�°" "`'• Expi+es occ 2
g�;
produced Cw "••, �HAHNb rStar; of Flonda
omm.
k f.E17: _:.,
- : - �?
„+�^ i ..,
- '�o y,• Dec 20- 201Y•
C`om�nlssion p<s'
;'. �a, Bondadth(o -Val') sl N.��'s'
Commission No. ���,�^' ea
iil Tres
Commission No. 2 a• ` 'I'���TI )�:!ff 177249
- o eal
a; p
0 Iihro+Wh National MOWY
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW'
"REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED -
DATE
COMPLETED
ev. 7/2014