HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
�•� BY
s ' — St. Lucie County
o - _
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 _Y Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Legal Description:
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Property Tax ID p: 31-3 S - 76 1 • Oob 8 -coo - O Lot No.
Site Plan Name: aoS So Block No.
Project Name: - S m
Setbacks Front NIT Back: NiA- Right Side: 6' Q- Left Side: A/
I.DETAILED DESCRIPTION OF WORK: 1
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CONSTRUCTION INFORMATION.
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�HVAC Gas Tank
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❑Gas
Perrna-cneCK an
Piping
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apply:
Electric
Plumbing
Sprinklers
_Shutters
❑
Generator
Total Sq. Ft of Construction:
Cost of Construction: $ go, con —
S Ft. of First Floor: _
Utilities:)Sewer Septic
Windows/Doors
Roof = Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Er2oSSo
Name:_Nlr_1(7kt 4'
Address:
company:-D?uC�Ehr /a&'tk
City: 5i- naff I q-, State: P_�
Zip Code: f 1 "] R(, Fax:
Phone No. ��SI / . /Lin,
Address: ��iJtl1AT
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�i72a
City: S vA-Vl r-
Zip Code: 3\1119 c(
Phone No. (O -z -oago
State:%L
Fax:.6'%-z Q? '
E-Mail: T
Fill in fee simple Title Holder on next page ( if different
from the. Owner listed above)
E-Mail: 9j A4le, ffW&Z.C(aGr)0,1/f% a J: - d.
State or County License:
It value of construction is S250U or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Name: GL?494 a 4CV417NaM
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: SuWy IUAgi pl_
grnrcr A1611a
Address:
City: :n
Zip: Phone /
State: _pt-
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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. Lucie County 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-r tdential use
WARNING TO OWNER: Your r e to cord a Notice of Commencement may result i/ryr aying twice for
improvements to your prop N ice of Commencement must be r rdec anon the jobsite
before the first inspe ki nt nd to obtain financing, consult h 1 ndei orney before
commenwp�k qfF�/r o i ou Notice of Commencement.
Signature of Owner/ Lesse o ractor as Agent for Owner
Signature of C ntractor/ i se Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF !37—
COUNTY OF ST X,0C11_`_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thiVp 4fay of l_T , 20 by
this/ ,'2 'ay of �/_T , 20Z
Name of person making statement
Name of persorymaking statement
Personally Known ✓ OR Produced Identification
Personally Known !/ OR Produced Identification
Type of Identification
Type of Identification
Produced %
Produced y /J
(SignAare-of Notary Public - State of Florida)
(Signature ofWbta�y Public -State of Florida )
Commission No. .,•a�PE'', ANN M.(I0ND
Commission No. .•'•"""?;', �gADMOND
V, •.: MY COMMIBSION 9 FF 173907
r ;+; - ;.= MY MISSiION B FF 173907
+'a EXPIRES: Decerther7, 2018`=
EXPIRES: Decernber7,2018
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BantledThmNoary ublicUrdemders
4 Bonded ThmNotagPubl'icUademiters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17