HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U c1
Date: permit Number:
SCANNED
BY
St. Lucie County Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
RECEIVED
APR 20 318
ST. Lucie County, Permitting
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �� rd Jg act
PROPOSED (IMPROVEMENT LOCATION:
Address: f���n s. C7CeA►v yob ` k&soS n. &A 3y9S1
Legal Description:
PropertyTaxlD#: �� 5` i o03�-do0-O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-DETAILED DESCRIPTION OF WORK"",
ens add�°. (� J2oom ; Gtemove- -P ieep(�►� s,^ is
VAV14 16-Jet. New FAveed fm iub,.
move L46ove- 5h?X-Sr.,-4cL.5 reii4ce. 6;C:f-, stvl44L- 4' Fir
CONSTRUCTION INFORMATION':
LJHVAC LJ Gas Tank I__IGas Piping
Electric Plumbing ❑Sprinklers
Shutters QWindows/Doors
Generator 13 Roof = Roof pitch
Total Sq. Ft of Construction:.> X7 = 3 5 SA.0-1 S Ft. of First Floor: _
Cost of Construction: $ % Oell oy Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:' ' -
CONTRACTORS
Name ,9U a
Name: /.&
Address:
Company: U So v k
City: Set4.5e-a QPAG State: f C
Zip Code:3 Z/ g5 % Fax:
Phone No. 7 7Z_ Z25 ,-S bn
Address: 4azs, 545 13e�%LV� -_
City: _K I'_ Stater
Zip Code: 7992 Fax:
Phone No. 7 L o p
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: N o 0 (' I'riC1�S .sue
State or County License: 19 0 . r2 Z
if value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
140
SUPPLEMENTAL CONSTRUCTIONLIEN 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/Co or as Agent for Owner
Signature of Contracto /License er
STATE OF FLORI A
COUNTY OF 5 I-yc
STATE OF FLO Ir
_ \R
COUNTY OF C-)
The forgoing instrument as acknowledged before me
The forgoing instrument was acknowledged before me
this�A day of 20L by
this30 day ofQ N 20_W by
�re�Qt;ek Q11�d.e5
�c<af;ck.all:ae�
Name of person making st ment
Name of person makin statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identi(i�cation
Type of Identification
Produced 11 L L
Produced �L
(Signature of Notary P lic-Sta t IE GNEN5p7J
(Signature of Notarybllic{- 1 GNENS j
�+�� DFAN 1SSlON#G"02p20 �
Commission No. Su�.!3'a 1MY C0f`N3embei ta• ,e=t,
1� YCO i SSIGN#GG 01023
Commission No. 62p20 t
DedeSealjUndepubva
Notaripob�'oUndeN+�
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLA
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
Rd
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17