HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -11"I Permit Number:
SCANNED
BY
St. Lucie County
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Acldress-.4-�qr) &nn-, IIIAW
�J 4 Q QS
Legal Description: 19-) --24 19 =1taJ C2 11 11'4 (�P It�02)"I - L 2 V) 0.1
1AI � �, ( 7: �r- rd n ja �� A on- c�f,'�Nw
Property Tax ID #: CYIOII� Lot No.
Site Plan Name: Block No.
Project Name: ((-)I,nn \Ni)Li;c
Setbacks Front Back: _ Right Side: Left Side:
I
-DETAILED DESCRIPTION OF WORK:
III, III T ('Uollslc�n
Ins-iI dluoj I I, U', I' I
-CC)r1n'eC4--f() EXti41k79f e112CFK/C 01 14)
CONSTRUCTION INFORMATION:
AdditionalWOMIQUe eflulmed unaerthis per nit - check all app Y:
1]GasTank-- -E]Gas Piping Shutters E]Windows/Doors
?Electric El Plumbing []Sprinklers Generator ORoof Roof pitch
Total Sq. Ft of Construction: Sq LLVL S Ft of First Floor: I
Cost of Construction: $ Utilities"n SeweroSeptic Building Height:_
OWNERAESSEE:
CONTRACTOR:
Name U QO�
Y-)rll
Name:—I�-(-Y-)
Address: c-, c'm I I V- LOW
Comp inI
Address! 7 V3
city; "inQ State.
Zip Code: Fax:—
Phone No.
ritf I Co vi i )a1xfx StaI
Zip Code: 0) Fax: )'JaL(q rz;'� 9,67s
E-Mail:
Phone No. 19112x9m
Fill In fee simple Title Holder on next page (if diffe ent
E-Mail: W 0 01
. cryn
from the owner listed above)
State or County LIcense:F-,);�')CC�("T1GLD
if value of construction Is $2500 or more, a RECORDED Notice of commencement Is required.
aPPL MEN :ONSTRUC7,10 NIIEN
U E TAL�,
RMATI W
7.
DESIGNER/ENGI NEER: Not ApPlicaDle
MORTGAGE COMPANY:
Not Applicable
Name: C,14IRiord LeWOY)-7
Name:
Address:
Address:
—
State:
City:
State:
City: —
zip: Phone,
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
—Not Applicable
Name:
Name:
Address:—
Address:
City:
zip: Phone:
City: -
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:Appllcatlon is hereby made to obtain a permit to do the worKandIlIbLdildLI...
I certify that no work orinstallation has commenced prior to the issuance of a permit.
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.
I
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 I
improvements to your property. A I`
before the first inspection; If you ini
nencement may risult In your paying ice for
t must be recorded and posteclon the jobsite
consult with lender or an attorney before
commencing work or recoraing Your muL
A"'g)nCA"i"
C
�
Sjgr�ature of Contractor/License Holder
sigriature of Owner/ Lessee/contractor as Agent for owner
STATE OF FLCIIR��..
STATE OF F A
COUNTY OF
COUNTY,O,
The f Ing instrument was acknowledged before me
this May of 3:�A 26fl_, by
The forgoing instrument was acknowledged before me
this day of L 20,7p by
I tic
)YM
C-
�Name-ofpeKs�qnrmaking statement_
Personally Known V OR Produced Identification
�--NTm—i�o-f-P-ers—oTffakirfg-statement--�—
Personally Known V OR Produced Identification
T�pe of Identification
Type of Identification
Produced.
Produced
STEPHANIE AR
.1 Myc0Mtv1ISSI0N#FF1
A(Sig
*o-flodada
-S October 2,
October
ary Public- St t idd�a4XPIRFS
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ISIVY5
yy MISSION VFF170898
y 0M
(407 Fima&4awyservicex
11 orgpol MgR Ra!ober 22, 2018 Sea[)
Commission No.. (beal)
;80153 FloridallotarySemce.ccrn
REVIEWS
FRONT
ZONING
SUPERVISOR
VEGETATION
'REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17