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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFOMUSTBE COMPLE i cu FOR APPLICATION TO BE ACCEPTED �1 Date: G a,'a,� \� SCANNED Permit Number:BY I St. Luce County- RECEIVED Building Permit Application �uiv 2 2 20)8 Planning and Development services ST. Lucie County, Permittin Building and Cade Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: �q� a ` 1 I qwA, Address: Lf Legal Description: Property Tax ID#: Site Plan Name: Project Name: Setbacks Front Back: r S-)_ COCS-Ca Right Side: Left Side: Lot No. Block No. Additional worK to oe perrormea unaer tnis perm¢- cnecK au inat appry: _Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNS /LESSEE: IM C©NTRACl®R: Name /gv6e4'r6 Name: t f-J a S. Address: `I0 ,,-1 � ��1 4(A- aN-i / Company: .S(!AAn City: FrSRT ?kFfl�CC Stater Zip Code: c;l Fax: Phone No. Address City: Vk-ZO �cA H l �L State: L Zip Code: ?72�(e 1 Fax: Phone No 722-ZZ4 (0(0 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail n f I a VL Q ktG"/CS (-n fV LX9I'�_ � State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 1111" EJ I_GONST UGTION LIEN W IN i ATION- DESIGNER/ENGINEER: Name: =P— Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Address: _ yn?_ CVG Address: City: fop Zip: Phone State: 777 3ivD City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable 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 other non-residential use WARNING TO OWNER: Your fail re to Record a Notice of Commencement may r ult in your paying twice for improvements to your prope . A Notice of Commencement mus a re r d and posted on the jobsite before the first' pec 'on. If ou intend to obtain financing, co der or an attorney before commencin o o r cor In our Notice of Commenceme q, (A�w . Signature IN s / _ ractor as Agent for Owner Sigof Co - actor/License Holder STATE OF COUNTY OF L�1e s STATE OF IDA COON OF Lvi,'P, The forgoing instrument was acknowledged before me a'a.day The forgoing instr ment was acknowledged before me this of by this Q60a.day of %)-rRt 20�AA by �'C A v1 Y14df g .P ( A h �1tiV LS 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 Identification Produced '�—\- Produced L (Signature of Notary blic- State of Florida) (Signature Nof, ., blicp$zs 'a n��a,EIRTddHc�1 �. ---�,".7athF�lE G1�ENS�tf My CO p;.S; pexmber 16, 2020 Commission No. ��, (Se�II.ISSION#Gr'U`'ZU�3 e�y CommI5510n�N{��".�. 4.+}, ,, �NotzryFuElicU'.�@'+� _zip•® my co `S. pecembzt i6. 2020 F}IPIR` "°::.`•,.• , � z PublieUnoenurile gown o` REVIEWS FRONT NG SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW ECEIVEDATEOMPLETED [DATE nev. o/ y i i