HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED SAY �
e : BY Ae�,,; n
St. Lucie County sr tH'S°,y
Building Permit Application
Planning and Development Services S /dos �zale
Building and Code Regulation Division �llc/P�epa.
2300 Virginia Avenue, Fort Pierce FL 34982 cO�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial �_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S 16)"
PROPOSED IMPROVEMENT LOCATION:
Address:.'-'.-& 0 L4D
"k VLO!4E!d
SzrJ ,
ice.
Legal Description: CAvVvCt
CtT!(
O5 36'40
Property Tax ID#: _2�403— 5-Oo1- oi56 -100 - 6 Lot No.
Site Plan Name: Block No..
Project Name: 02UA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
i2-9i1�t6-C7�L '7' ' ` rh6-� �6 S tCq►' `J F 29-C'i �-iC.�SSI � C� �0�.1JKe+•�S-'''xC�,J.
L- Le-D 101.hPL4-..( t- 1urcQ JvH(N tLl.JnIJ#4r_%'f7htC7�j
CONSTRUCTION INFORMATION: III
Afldttinna wnr to ona nrma nrt n or1 is norm—r nr r nt nnn
[❑ ❑ VAC Gas Tank ❑Gas Piping ❑_Shutters ❑Windows/Doors
lectric 0 Plumbing ,Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: -7 a S Ft. of First Floor:
Cost of Construction: $ h, 3 DO- 60 Utilities.
Septic Building Height:
OWNER/LESSEE`.
CONTRACTOR.y
Name
Name zbT2T21,�- -D.6�A L
Address:: 6 foa to • rt.o W 6,4 (2-0,
2
Company: -
City:..t*- :9 k State:
Zip Code: 3Y 1 Fax:
Phone No. QO,,':�-4igS- y IQI
Address: Lt+R u:' f `� covl VTR cs`i rta
City: 5 TV A.P r State: 'i=C .
Zip Code: -2 Fax: '3a0-77GIT
Phone No. aa.0-'7�i77
E-Mail: NT%a5L4�j Q�lA%jg=' j F., Pig-CcR_.La7'I
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: F LM rtI GoS l y r LS �f4 B L Cp r�
State or County License: (� S t 3c10 N %A4C�
It value of construction is.5250D or more, a RECORDED Notice of Commencement is required.
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 financin der or an attorney before
Comm work or reco our Notice of Comm e
Rev.S/2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: SAri� C�a� �
MORTGAGE COMPANY:
Name:
_Not Applicable
Address: t aao t S � C�'t.�i3
�-(
Address:
City: l�ll'C9��
Zip:"'�3�155 Phone aG�-
State: �L•
aC�'7"�
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
✓Not Applicable
Address:
Address:
City:
'City:
Zip: Phone:
Zip: Phone:
Signal re of Owner/ Lessee/Contractor a ent for Owner
Sign r License Holder
STATE OF FLO
STATE OF FLORIDA
� 4
COUNTY OF
COUNTY OF � 7-
The for ing instrument was acknowledgP]cLbefore me
this day of � 4''/ . 20_ by
The for oing instrument was acknowledged fore me
this � day M'1 Y 20 - by
/
0\ D O g ti7 (f-�/L t,/} /�
////of
/� _
l�� d /J [`/r-7 //�-,mot it � /I/r
Name of person making statement
Name of person making statement
Personally Known FOR Produced Identification
Personally Known / OR Produced Identification
Type of Iden/t`/ification
Type of Identi ation
Produced /!4+ / l c<r.5
Produc(e�d��Q
�/�j- //Q%�./
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida j
Commission No. � `Nolary�5®al�leteo+Fladda
110
Commission No. � Nomry�pL)Mcs+a+eolFbrida
�;
Robert M Rice
Robert M Rice
c ' My Commission GG 072776
a?and�
g e My Commission GG 072776
Expires 04l031202t
�1 0� Ex Tres OC1032021
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