HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO -]BE ACCEPTED
Date: 7LIi SCANNED Permit Number:
BY ERECEIVEDSt. Lucie CountyBuilding Pernit Application8
Planning and DevelopmentServicesBuilding and Code Regulation Division rn
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line KtIl b III
PROPOSED IMPROVEMENT LOCATION: III
Address: q00 k- 'Pl; M0 v;.gcf B1✓Cl
Legal Description:
PropertyTaxlD#: 3y\°`� a6d3� (31t,0-1 Lot No. /�,
Site Plan Name: q'iZ C Ne rj-- 4, I Block No. /3.57-
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�pp�� Ilcw I-,} f d`o� LUG I lS
'rude, l Lp � t F mr rex 08C MeiChi (
CONSTRUCTION INFORMATION:
Additional work to e nertormed under tis permit - cneck a appy:
EJHVAC Gas Tank ❑Gas Piping _Shutters 0 Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: <_nn S/L S Ft. of First Floor:
Cost of Construction: $ 51 -A c.o Utilities:Sewer OSeptic Building Height:
OWNER/LESSEE:
o
CONTRACTOR:
Name ,Cf jzJ4 An
"tetI
ame:46trv{ aidat
n1 � ;-L
Address:gUU C �r:M4 V`s1e,
Company: :t
City70r4 �4 Lye: Q- State: V-
Zip Code: 749) 8L Fax:
Phone No.
Address: le R Sw _', M Qot
City: i?- SC.. State: FL
Zip Code: hiii 753 Fax:
Phone No. i i Z- S-7I - S-7 5 1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Fro,,V;, 6 1 ) ro Ace.)
State or County License: CJ c. Ia I -Z 6 N
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 Count d makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con liwith 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 OW ER: Your failure to Record a Notice of Commencem t Wayre n your paying twice for
jmprov ents t our property. A Notice of Commencement mus a rand posted on thejobsite
befor t e firs spection. If you intend to obtain financing, co witor an attorney before
com a cing rk or recording vour Notice of Commencem t.
/tureo
SignatLWof Owner/Lessee/Contractor as Agent for Owner
Sign ontrador/License Holder
STATE OF FLORIDA
COUNTY OF �. ty
STATE OF FLORI9A
COUNTY OF �^l •
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this dayof-*fN 20 by
thisa day of �"�i 2U by
'�iqnk CsoAi'�e('
�ray.lc CzaJa-��.f
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 Identifi�}tion
Produced L 1��
Produced t--L tQt
wPubli
(Signature of Nota a of Florida . �
\
(Signature of Notary Pu lic-State of FlorjJ1 l
NSGEp,
�(5� Migy GGO'L2020
Commission No. S'o, s
_ - NJIRIE.GNE01021 1�
Commission No. — e
�'a%i•°`•"�ti'.,: MY P\�5�perFpy (w�ndevNntnC:
•.:?:.eti4y�'.: MY GOME1 �eteNbet �UnJeniAi=^1g
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REVIEWS
FRON °'f�'�
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SUPERVISOR
PLAN
VEGE1'YI
TSEA U
MANGROVE
COLIN -
REVIEW
REVIEW
REVI
REV
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
-ALLO* CASLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 �5 ��64
Permit Number: Date;
Application
MAY 0 218
Building Permit App � Pin
Planning and Development Services
uciGuity� _
Building and Code Regulation Division Residential
2300 Virginia Avenue, Fort Pierce FL 34982 Commercial
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line f
Address:
Legal Description:
• Illlllyi1M
property Tax ID #: ' � "
Site Plan Name: &T& C AA "
el
Project Name: Right Side.Left Side
Setbacks Fronts Back:
Lot No.19
Block No.13.5-_
w+,....... _...
)ETAILED DESGRIPTIOr ,, .y S
nt�J 1,0v `tar (iUG
x e 3 � Y
CONSTRUCTIONINFORM, TION; ,, ,- aPpY:, s„
mono war to jje��jej orme under is permn in ec a _Shutters ❑windows/Doors
�HVAC 11GasTank ❑Gas Piping En Roof pitch
Electric � Plumbing ❑SPrinklers
Generator 4� Roof
SF S . Ft. of First Floor:
Total Sq. Ft of Construction: �nn
au Utdities:LJSewer ❑Septic Budding Height:
Cost of Construction: $ 5-
III City:
Z
Fax:
State: V L
Phone No.
E-Mail:
Fill In fee simple Title Holder on next page ( if different
from the owner listed above)
if
is $2500 or more,
Address: State: rL
City:
Zip Code: 3`{di_Fax:
Phone No. 7 Z 5_ S% S 1
E-Mall: r0^ ,x I IUD A Mti•1
State or CountyLicense:cNc i16 61—
of Commencement