HomeMy WebLinkAboutBUILDING PERMIT APPLICATION7�
ALL APPLICABLE INFO MUST BE'.WMPLETED FOR APPLICATION TO BE ACCE,,.'J Date: ,(� Permit Number: I Dcis"cico
SCANNED
BY
St. Luci 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 Residential
MAY 01 M
Permitting Department
St. aide County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: III
Address: /0 0 3 a
Legal Description: ST ;-vc-J-e.
C 42.D Ern c 61
40 SLe� 3 N Soo FT o f=
v k- L¢a4-
i S 4. ! G o FyS �t
62. Sfs P `/ L/O) S 1 (o r 7S)-
Property Tax lD#:
3Y--SOI
`
3-71S— 0S0—i
Lot No. /S 73��
Site Plan Name:
5 e v �V\
Block No. .3
Project Name: m
L::kPc-=l
S/kL-ate
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
9, Gt+PrV\n2L 14, s;5n r^ 03r.J-9-CA
L U
D-A nco.���
kr��P�� s rt i ✓tom i✓ l--ems-r • � �''- � 1
CONSTRUCTION INFORMATION:
[1HVAC Gas Tank ❑Gas Piping U Shutters ❑ Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sct. of First Floor:
Cost of Construction: $ / 20 0 Utilities:1]Sewer E]Septic Building Height: 20 r
OWNER/LESSEE:
CONTRACTOR:
Name y^L
Name: Eri l.o1 0 e 2 il,A-C r
Address: /60/9 /V /07 7, S-(-
Company: 51 Gl11 C.DA Y1 eCTi,3n
City: 5 , 4-1-c d/ /:e State-J-�--2__
Zip Code: !jc < 2 5 rc- Fax:
Phone No. 6o2- — eye % — OX/%
Address: 10 2 29 S C L L1/V Al /k �
City: P, r J- S.-r Z_ . c•' State:LZ
Zip Code: 349 S Z Fax: �37-OscO
Phone No. 77 2 - 33 C- 2 �4 c+ /
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: S f G aJ c_7 ex n , ur Psi Q
State or County License: N " L .r� . `u K
1--'5 2O0 I 3 6 U
if value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CON
LIEN LAW INFORMATION:
Not
Name: K.
Address: I q cs t ado- f,. r-e_ S --
City: „ C= ns L_ State: f3 L
Zip: 3u� 4�_Phone -7fss,;?e&<[
FEE SIMPLE TITLE HOLDER: t/Not Applicable
Name:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
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
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDy�.,CI
COUNTY OF
The for ping instrument w s acknowledged before me
this C71day of 1tpV1 20JI by
Name of pers9if making statement
Personally Known OR Produced Identification
Type of Identificatiori
Produced
of Notary Public- State of Florida
CommissionNo�/0f1S/ n40eeillibuara estateofFa
Magna L LouderDaak
g, My Commission Op 108810
E)om 0810712021
REVIEWS I FRONT CO NTER I REEVIEW I SUPERVISORNING REVIEW
Rev.
Signature of Contractor/License Holder
STATE OF FLORID 1`
I L��
COUNTY OF �Lf
The forgoing instru ent as acknowledgeSbefore me
this day of 201 by
Ord Lgt� etc C
Name of pe o making statement
Personally Known OR Produced Identification
Type of Identification
(SlIgnature of Notary Public- State of Florida j
I Florida
k
108810
PLANS VEGETATION SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW
slls��