HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: iuci-n(a
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
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<�qo 6nQ-, �Ui
2 �J fiings
Legal Description: V27) a2
'A
<,zsc-,P -E� cy) G L-3- c-,,P'�,,w
Proper ty Tax to #: VN�2)-,97�a Lot No._
Site Plan Name: Block No.
Project Name: h)\on
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK-
)m4all )HOymir?L-4,19-d Ck)L C 1 4n +_0 CAO q-
-e_xls�kY13 Qkc-16fl C- I or 9
CONSTRUCTION INFORMATION:
AaclitionalworKLQUe ellulmed underthis permit- c ec a app Y:
EIHV [] Gas Tank []Gas Piping Shutters E]Windows/Doors
aElectriW Q Plumbing OSprinklers E]Generator CRoof Roof pitch
Total Sq. Ft of Construction: - '10 J V� S Ft of First Floor:
Cost of Construction: $ C) Utilitles'll Sewer ElSeptic Building Height
OWNERAESSEE: .
CONTRACTOR:
Namell
(-Ly- Qn-h(y-)c,(
[+s-,-_c
Name:=an—TrJffF+KA
Address:75591 1,3 LCMD�Y'hyd.1-ULL�
Company-rAY_r, rl� M (-L�7 11
City; "if,)G State:
Zip Code: Fax:--
Phone No
Address: V�0f�_) 41 a_lL 74 13 -A:�-)VSR
cityC_1My1&P4,r/ _ State:_3L
Zip Code: 01"�l ( 0;�; Fax:
E-Mail:
Phone No.SE:E9M
Fill in fee simple Title Holder on next page (if different
E-Mail: w n n),
r(yn
from the Owner listed above)
State or Count� License:
I
If value of construction Is $2500 or more, a RECORDED Notice of commencement Is required.
SLI PPLEMENTAL-�qNSTRLI&I(JN LIEN -LAW INFORIVIATION:'�
DESIGNER/ENGI NEER: Not Applicable
Name:
MORTGAGECOMPANY: —,Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Narne:
BONDING COMPANY: —Not Applicable
Name:
—
Address:
Address:
—
city:
City:
Zip: Phone:
Zip: Phone:
OWNER/CONTRA rOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and insianabvii ab lutuicateu.
I certify that no work or installation has commenced prior tothe issuance of a permit.
St. Lucie C
which is ir
structure.
to
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 f ull 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
improvemen ts to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection; If you intend to obtain financingi, consult with lender or an attorney before
commencing worK or recorumm.yvul 1-1— ......
.........
/,I A 1
CA141711
Signature of owner/ Lessee/Contractor as Agentfor owner
Signature of Contractor/License Holder
STATE OF FLPT(ITA
STATE OF FL?5pDA_
COUNTY'OF
COUNTY OF
The forgoing inst�rumen� was acknowledged before me
by
The forgoing Instrument was acknowledged before me
this day of &J�L 20.t- by
this 12OR
day of 2JC�±
_a_ j
r)y6 ( H(hllkC
HCC�7.A(K
Name of person aking statement
Personally Known Produced Identification
Name of per�7aklng statement
Personally Kn wn _OR Produced Identification
0
_!�"OR
Type of Identification
Type of Identification
Produce STEPHANIE AR
Produced,
My COM�ASSION #FF1
FXPIRES October 22,
STEPHANIE ARC
'F� .5._
Aeof �Ioril�da
igna ure of Notary Public- Sta o Florida
r.8
qoi;mj!�a
(Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPE ISOR
P
VEGETATION
SEATUIRTLE
REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
RE IE
REVIEW
DATE
I RECEIVED
DATE
COMPLETED
Rev. 8/2/17