HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (��y
Date:0512.Slig SCANNED Permit Number:
BY
biSt. Lucie County
Building Permit Application 0.Etuto
Planning and Development services 2110i�
Building and Code Regulation Division Qe�`u . cou ty of
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
LPERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address: �JIJVIJ \� 1JUP--Lc i Ur I 11 n 1tiearr) , I.L. 3yh5-i- lA�OM'* 1506
Legal Description: EM PRnW�1�I CONDOMINIu-M UN Gi IT 1563 �OIZ 2195— -2)
Property Tax lD #:y5n- lD2D - 0111- 0WD_ g Lot No.
Site Plan Name: EMPRESS/�CDIJDoMIWiUM Block No.
Project Name: Gep sqM ReSldmee.
Setbacks Front 1.1Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
RemovP, and replaee (1) eltry 0IbDr. (TAPZ+)
I CONSTRUCTION INFORMATION: III
❑HVAC ❑ Gas Tank ❑Gas Piping
❑Electric ❑Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 112.00 •(0
Shutters � Windows/Doors
Generator ❑ Roof = Roof pitch
S'c Ft. of First Floor: _
Utilities:Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam
I
Name:. 1
?i
Address:
_
INN
Company: 1'e, ( SS PrD
Ssara�S
City: �e �/A1� �IQIn State:
Zip Code: 3Lg5J Fax: N A
Phone No.1- 3I oo —
Address+::35% SE DIXie HWV
City: JrI"i State:
�AtLl"n`IIQ Fax:
Zip Code: ✓
Phone No. 2' 2 G - 045q
E-Mail: COMO
& qi WL
CDm
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: W5DrOS QMi5U
1. CO
State or County License: 1 .3U-S
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 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 Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of contractor/License Holder
STATE OF FLORIDA ✓L
STATE OF FL n
COUNTY OF��I f I n•
COUNTY OF�� I 1
The fpcgoing instruT�Z acknowledgebefore me
this y day of 20 by
The forgoing instr a as acknowledg efore me
this iv day of 20 by
Imo-l1i6 1- mn(1e
LE -Mid L-W)ra o.,
Name of perso maki g statement
Name of persoymaking statement
Personally Known � OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produceg
4 .
Produce'XM rxa A� �- )CJ�00�
(Signature of Notary Public- State of Florid )
(Signature of Notary Public- of Flori a )
Commission No.C-;1�5� 1 (Seal)
yState
Commission Nd 'C Pl 16 � I (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
,
DATE
COMPLETED
, 1,
Rev.8/2/17
SARAMAESTAGMILLER
,. MY COMMISSION# GG 1785711
;?: ? EXPIRES: January24,21M