HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONe
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:Ron-ol-7LI
BY 7ua'U pea a!,n7'7S
_: � - St. Lucie County °6uy71aaad
81016,p 1IU
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 X Residential
Oa419D3a
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineC(�C
PROPOSED IMPROVEMENT LOCATION:
Address: le 2)9,tn-.
Lega I Description: 20 35 40 from pt 25 ft e and 25 ftn of sw cor of ne % of nw Y. of nw Y .run n al gerlw s39 st 208.90 ft to pob. Th cont n 104.46 ft the 140ft.th
104.46ft. th w 140 ft to pob (17a) (0.27 a) (or1896-2570) _
Property Tax ID M
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
you` Oq (0' 6oU wed epee wl qc�:Ve-
CONSTRUCTION_ INFORMATION:
❑_ HVAC Gas Tank 11Ga5
❑Electric OPlumbing ❑Spi
Total Sq. Ft of Construction: h
Cost of Construction:
nn:- cnecxau apply:
Piping _Shutters
nklers Generator
_ S Ft. of First Floor: _
Utilities: Sewer ❑ Septic
❑ Windows/Doors
❑ Roof = Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 3WL 2`.SSnC,
Name: nGll�e_
Address:'% Si .00C�CGf"Q-ce-r.
Company:•�el C 5
Address: r��Yt `J )c `r
2nCC ( r II
_N e iSori �T,
City: h�4�C1P C-Nno � A State: SL
Zip Code: ��ySrJ Fax: CV ok
Phone No. See C' phkt C.6-U'c-
City:
Zip Code: _JLVC1cLi
Phone No. 'I I -
State: (-
Fax:_1 - ' �J
E-Mail: c o-'C\�-rC rztac
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
ri�eF�/ _ (Db `1
It value of construction is ,i2500 or more, a RECORDED Notice of Commencement is required.
7
s,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ otApplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: /\ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
Zip:
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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, 1 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si nature of Contractor/License Holder
STATE OCOUNTYOFORI
STATE OYOFORIDA
Ma Yt
COUNT-\-,t
The f oing instru�nt was acknowledged before me
The f ing instrument was acknowledged before me
this day of 1L�YIw 20AI by
this ay oft ci)c . .201 by
Name of person making statement
X
Name of pe s n making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification 2XVp
Type of Identification
Produced R00" W t-Q5.9arp. 5- LiLQ)r O 1411
Produced
(Signal r of Notary Public- State of Florida )
ure of Notary
is-�Stat - '
Laura W. Caswell
Commission No:�l q< NOTARY PUBLIC
STATE OF FLORIDA
Commission N
„•p,;:'•�,
: •o` S NN ON C. EY LDS
=d• �? ( 07ff
c• . • .= u Ilc - 1 Florida
g o
•: ie Comm#GG227219
y• .a,5 My Comm. Expires Sep 19. 2018
%'.,;eoF no c commission # FF 151118
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
„��p
DATE
COMPLETED
Rev.8/2/17