HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONpoc,_/ 21, 91
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:A�20)ig, SCANNED PermitNumber:
BY
MCI ME- St- Lucie County RecErv"D
Building Permit Application SEP 2 "0 2018
Planning and Development Services Permittz.,
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Wig �,,,rtm,at
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Gunty
PERMIT APPLICATION FOR: To Select from dropbox, click arrow' at the end of line
PROPO�Eb'tiOPROVEMENT�LQ,lt4TION:,'.,,,,5
Address: 7t'/ z 0� -S crcr__4r�- OrW-e—
Legal Description:
Property'raxICIM352-2— 22
Site Plan Name:
Project Name: S4^_41
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
J'PET LEP D"�RIPTION OFWORK.
Ae M r- S 517e�_91�r,
-:2�vPzll 3V3 -*,4 c--
CCINSTR N ATION-
�LICTJICI' INFORM
MUU UVII01 WUIM LU UnCI'UI I I ICU UIIUCI LIM PVII III L-LI
11 HVA GasTank E]Gas Piping
11 Electric 0 Plumbing [ISprin]
Total Sq. Ft of Construction: _&9 (�7
Cost of Construction:$ 300,;;t e"
LiShutters Q]Mfi0l5ws/Doors;
ElGenerator tj�rRoof EF1 Roof pitch
S . Ft. f F1 t floor:
Utilities: Sewer E]
Septic
Building Height:
,bWNER/ ES�EE:,
R:
Name ' s4e,��
Name: OasA_
Address: 741 3 L:,'o c,4� 0/c
citv: *::F�,-�V_�v Ala- 4 State:
Zip Code: 39cZ5'7 Fax:
PhoneNo.__
Address: 3�125 ls'71r
City: & //4 0,
Zip Code: 3 Fax:
Phone No.
State:/C��-
E-Mail:
Fill in fee simpleTitle Holder on nextpage (if different
from the Owner listed above)
E-Mail: C�
5 -2 e;Z, C--f
State or CountV License: C6 C_
C, 0-3 5
It value of construction is W5UU or more, a RECORDED Not -ice at Commencement is required.
N
ATII
,f,�f�MEINTAL CONSTRU 614-
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
—State:
FEE SIMPLE TITLEHOLDER:
Name:
_NotApplicable
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.tucieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cortWict 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, svAmming pools, fences, walls, signs, screen rooms and accessory uses to another non-residenfial use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. o . ce of Commencement must be recorded and posted on the jobsite
before the fir ection. If you nd to obtain financing, consult lender or an attorney before
commei�i I =1 r c r mrordin ur Notice of Comme cement.
'S'1gnatur5j,fr6 w-ner/ Cessee/contractor as Agent for Owner
�Sifr'iture ntracfor/1-i—cerilse Holder
STATE OF FLORI!,o
COLINTYCIF
- F OF F! ORI
WWJ'4'^�
21
CID
The forgoing instrum was alo;nowledge efore
The forgoing instrument w acknowledged before
me
"by
me
this 2,F day of T�, 20 I
this,95 day of 1�4 20 _Lfby
'q�'
a
7e��
-SA
Name of person maikS'pg statement
Name of pirson ma!k!inZ statement
Personally Known __Z�_R Produced Identification
Personally Known L----UR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
RI-IF—PARI S&ROWN
(Signature of Notary Publi State of Floildn
(Signature of Notary Public- State of Florida
Commissionil GG 172136
7W
0
Commission No. ;7,'MA". Expinis Apr 26,2022
Commission No. (Seal)
10," �kw
I- Budedrhmu9hNaknaiNo1WASW.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/, 7