HomeMy WebLinkAboutBUILDING PERMIT APPLICATION7
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I R
Date: SCANNED Permit Number: ` p I O' oI ("S—
BY
St. Lucie County
Mill 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
P,.ROPOSED IMFROUEfVIE_NTLOCATION:
Address: 3100
Legal Description: A
(As per 06 No Fi ri-9 xull1fid Can 40q-) o tJ
Property Tax ID #: 11629 '0WJ)' — CkD6 1-7 Lot No.
Site Plan Name: n Block No.
Project Name:vl�c
Setbacks Front Back: Right Side: Left Side:
(_DETAILED DESCRIPTION OF:WORk
CONSTRUCTION INFORMATION:
Itlonal WorK to De pertormecl n ert rs permit — cneCK all apply:
OHVAC
Gas Tank
❑Gas Piping
_Shutters
11
Electric
Plumbing
Sprinklers
Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 2f('jDb,
cc
S Ft. of First Floor: _
Utilities: Sewer 1:1Septic
loft'
Windows/Doors
Roof = Roof pitch
Building Height:
;OWNERJLESSEE:-
t...._.
_
CONTRACTOR
u,
... . '
Name
P
pS
LLC
ame: /e�x
lnJ--Y" ciur zfeo'o .
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Address: O IJCJl(
�yJ3
Company: J)AL0 >
(.IOU.N &-
City: DRY' ieQee
zip code: 31919 Fax:
Phone No. '77') y6 Y ag 98
State:
99o2-yby-Da4J
Address: $1.7g 'TPtgE Top 'ML-
City: err p:c:rc-r-
Zip Code: 3L1075I
Phone No. -7ii -
State:
Fax: -772 i/6y Ozzz
6(S - 96`77
E-Mail. "Ar- le Q6k =�*4N.Cory)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail::% QbOt
t(EMa.S ow�Y2 .� . Cl�M
State or County License:
!;" '300 L
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL -CONSTRUCTION LIEN,LAW INFORMATION:,
DESIGNER/ENGINEER: _ Not Applicable
Name:_ -zrJr ft1L fV'1uVtL +—S
Address: gob h l+wwc IA11¢.
City: ;f4 Puce Stater
Zip: 3yy5o Phone `nr-- L67• a iq
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
Zip:
ne:
MORT��QQG� CO PANx _ Not Applicable
Name:�P/js 13tq
Address: nJQQ1,ds
City: Qte-e - State: rl
Zip: 3q%2 Phone: *2 06361
BONDING COMPANY: ✓Not Applicable
Name:
Address:
Zip:
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 Countyy 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, 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 insp n. If you intend to obtain financing, consult with lender or an attorney before
commencing wor or cordh'Q vour Notice of Commencement.
as Agent for Owner Signature / c se Holder
STATE OFTLORIDA STATE OF FLOJDA
COUNTY OF �} i r , CL COUNTY OF '3r
The forgoing instrument was acknowledged before me
this ! day of 0 C)C 20_XS(,by
Name of person making statement
Personally Known - / OR Produced Identification
Type of Identification
Produced
JANAL.
The forgoing instrument was acknowledged before me
this C�. day of OCA 20Aby
lAh q aj 6
Name of person making s atement
Personally Known OR Produced Identification
Type of Identification
Produced
:�+?✓gas JANAL.SRIDGES
Commission + #GG022Wal)
.i a` Expires September13,2020
� P.T7kS`'� BandeATtvuTrovFaNlnswnee 9093957019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17