HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
Planning and Development Services 4/1 31
Building and Code Regulation Division pe'r777 ', IR
2300 Virginia Avenue, Fort Pierce FL 34982 st"tunvo
4LC10 5c*t'o
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential "Olint), ent
Address:
Legal Description: 0 C_
Property Tax ID #: q05-7) 2- -,5p a Co(oo- coo -s Lot No.
Site Plan Name: Block No.
Project Name: 0)A3i(V,- t 2L4
I Setbacks Front Back: — Right Side: Left Side:
-ctp lac,,e, 461 "P� 9J0'-'-'5 CLOC) f25 U0 r4)
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Additional worK to Oe-pertormea under inis permit- cneCK all apply:
11HVAC Li Gas Tank E]Gas Piping Mutters []Windows/Doors
11 Electric 1:1 Plumbing []Sprinklers ElGenerator E]Roof = Roof pitch
Total Sq. Ft of Construction: S'c Ft of First Floor:
Cost of Construction: $ 5-aia Utilities: Sewer E]Septic Building Height:
U2,11
11111
0 INT 4 , pig C.gEM IMP
Name M a, n-_ K I \eq
Name:
Q
Address:-122-0 --ft - � �AX b�>r C�ne_ VE
Company: oA-6 t
ya�A hau 'L ) _nC' _
City: 5"Iru ej, il�- State: VL
Zip Code: 3144Ct1- Fax.
Phone No. 3-zk — q%+q 06 16
Address: 3411 tslr--
Bct_V_eV KA
City: — S_Vulo I +-
Zip Code: �4CI44
Phone No. -:!3 :B 4
— State:_t.
Fax: 334 — If 0-79
— I 13k I
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: In�0'p-A-0—
J)A -6 _t"
rx-o - ILe-*
State ormyLicense:
450C (31 t 45-1263
II
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 4160.— 11
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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, 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
rnmmencinc work or recordine vour Notice of Commencement.
Signature of O ner/ L ss /Contractor as Agent for Owner
Signature f Co ractor/License Holder
STAI OF LORIDA
STATE FLORIDA r^ifAt I
COON OF
COUNTY OF 11lCLr
The f r oing instrulnen(was acknowledge efore me
this' day of 1111 20 by
The forgoing instru en was acknowledged before me
this �_ day of J 201$ by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification .
Personally Known OR Produced Identification
Type of Identifications
Type of Identificatiori
Produced
Produced
(Signature of Notary Publi - State of Florida)
Signature of Not ry P iblic-
`` r
Commission No. ""'< i�1kloid NIELSEN
�'
e� ��y eG r s •W. N tery ubl a State of Florida
C mission No. Oq r .7 0 `h 1a ne Hall
_ _State of Florida -Notary pu
- •_ Commission
lic MycommsssionGG207585
Expires
# GG 20748
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ppod' 04/15/2022
My Commission Ex '
e 022
REVIEWS
FRONT
ZONING
LANS
VEGETATION SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17