HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICAUE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:
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BY - :,7vy �,,
St. Lucie County Z,
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Building Permit Applicat Fqn AUG 2 7 ZoI8
pe,�
Planning and Development Services ' D err-Iittirlg Department
Building and Gode Regulation Division " i
2300 Virginia Avenue, Fort Pierce FL 34982 St' 2-uc'(-� COur)fll FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia-1-'
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: 111
Ar WrOYMA ru�
119,
Property Tax to #: !��o�Vt
SitePlaRl' me: �rC,9L-Ke-cS
Project Nall%le.-_trrhr_�
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side:
-000 0 _U6(NV
Block No.
4ft Side:
6- �? 1 T--- ) -s- I
CONSTRUCTION INFORMATION: III
LJHVAC L_J Gas Tank L_JGas Piping
11 Electric El Plumbing [:]Sprinklers
Shutters Windows/Doors
Generator J�Tlloof Ff_Lp�:] Roof pitch
Total Sq. Ft of Construction: //0 -S4 it S Ft of First Floor:
do li Sewer Se
Cost of Construction: $ c2 Utilities. ptic
I
Building Height:
OWNERAESSEE:
CONTRACTOR:
-
Name-Ro.,
Rk 3- C�-,V_Ecb
F
Name:s_rchen�Lwr 11iiscf,0910-11-
Address:_L1'1q9 [,J. AJA�,,Ajd L51
Company:
C)
, e State: V2,
City: �rD jqre
Zip Co . de: _3qr?LM Fax:
PhoneNo.
Address: /OVA k� <-/,V.
CityAem kynttA State:a -
Zip Code: Fax: 17,2
PhoneN1.r111-
E-Mail:
State or County License: 16,ZVAWv-�
E-Mail:
Fill in fee simple'ritle Holder on next page (if different
from the Owner listed above)
if value of construction Is $2500 or more, a RECORDED Notice ot
is required.
NU fbN ffi&��A
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: M 0)
Name: n A'e-
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_NotApplicable
BONDING COMPANY:
—Not Applicable
Name:
Name:
Address:
Address:
City:
city -
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVrr: 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.
no
:e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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
ccmmend xa,�A, ^r rarnrrlina umir INIntirp nf rnmnnPnrPrnPnt_
Signature of Owner/ Lessee/Contractor as Age
%�%_S,Wpgr ',�Ignature
of Contractor/License Holder
STATE OF FLORIDA
STATE OF F L RI A
COUNTY OF
COUNTY I&D
The forgoing instrument was acknowledged before me
The or inginstrug*nt was acknowledge efore me
L5LVCav Tby
this day of 20__ by
�
—
&AA0-
v-
Lk
Name of person making statement
Namebf pe�s§p4naking
statement
Personally Known — OR Produced Identification
Personally Known V%
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
-qSjFn`afu`MeofNotary Public- State of Florida)
(Signatud 0 f
Commission No. (Sea[)
Commission No %
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
Rev. 8/2/17
Mollor
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name: nDA*e_
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _NotApplicable
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.LucieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conWict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Assodation 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 tfie 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�o 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
commencine work or necordina vour Notice of Commencement.
�as.Agen,t-qr_0, er
Signaf-u f Own&rLegs� e �C_n-ffktPr
Signature of Contractor/License Holder
STATE OF FLT
STATE OF FL RI A
COUNTYOF
COUNTY'
The forgoin�ginst entwasacknowledge beforeme
The 4or Ing instru7i�nt was
acknowledged before me
by
this da of 2(11 by
th day of
I:
y �CCAOW
____7 Name of p rsoh making statement
Name!of pe[s�Making
statement
Personal' V�7 OR Produced Identification
Personally Known V%
OR Produced Identification
Type of Identification
Type of Identification
Produco
Produced
4299-etu
t Vlic K
Af IMMM=1851 #=F238;4195
(Signat of N
ud
AWGUER ft K
Commission E)
Commission No
My COMMISSION # FF 38495
Bonded Thm Notal Pubk Undenffbm
REVIEWS
FRONT
ZONING
SUPERVISOR
VEGETATION
SEA TURTLE
MANGROVE
COONTER
REVIEW
REVIEW
EVI;
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
RECEI
Rev. 8/2/17 SEP 0 5 2018
I ST. Lucie County, Permitting