HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•AII AFIP'LICABLE INFO MUST BE CO TED FOR APPLICATION TO BE ACCEPTEI - O� l ^
Date:
Permit Number:
SCANNED
BYc°
St. Lucie Countv �Ci j 9018
Building Permit Application
oeDa�ment
Planning and Development Services PeSt.1.u, County
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:
�J ' ONeft E :
_
Address: /0350 S. OCi�AA/ Dr2, Y�XJ$BT/ ge7tctt FJ_ 3c/q[.!'T
Legal Description: // 37 r// S 2`j . !S FT ON A/ 90/.579 FT Ly6- E pF A/q _LESS
S .S D F7_ OF At looFT of F Soo 45 a! Dh>X 1-7 / - 3?/ (3 ,0Ae_)
Property Tax ID #: 'tls// - // 0 -600,3 - 006 - 0 Lot No.
Site Plan Name: WAvr`L AA/D $ rrtc N #Olhzk Rb5;7;aW,7,S Block No.
Project Name:
Setbacks Front Back:Right Side:( LeftSide:d_
QC/'LAc� ��rraoam dvrcoiu`s- !�� l(/�hl R�S7�+1r1-r .Q✓r�rM�---�REtisr canc2� 57xti�ru�¢E
7a /2C 5e; we5rof CCCL Ormte�sl�rvs ��'-G'cN >/'-S"L X SILO°%/
FL APP2avxL -4- 1$000. 6y
A rtiona war to epe orme under this permit-c ec all tatappy:
Mechanical _ Gas Tank —Gas Piping _ Shutters -Windows/Doors
/Electric ✓Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 4 SOS- a Utilities: ewer _Septic Building Height:
-
r R
Name ST. LC(crF Gt vry XoCC
Name: E-4. U 121��®I�PL
Company:
Address: 23ao
City: F7-, Pr&�Z46 State: FL
Address:_ �O 0 1 (� t/1 icy "1/
Zip Code: 3q9 S I Fax:
City: ��p r } �j2�Yp State: FL
Phone No, (77Z) 1{( a'- 0 5-5/
Zip Code: Fax:
E-Mail: 914urvin, @ Sy-tuuEcD, oe/'-
Phone No CIAtSb`Jd6 5,40(ff-Crl OCR
Fill in fee simple Title Holder an next page ( if different
E-Mail J
State or County License
from the Owner listed above).
If.value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LI LAWEINFORMATION
a ,......,
_ .N
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: see Plans
Name: See Plans
_
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
N a m e: See Puns
Name: See Plans
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 antl 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Owfierl Lessee/ContraCtor as Agent for Owner Signature of ConV6ictor/License H der
STATE OF FLORIDA
COUNTY OF ---
The forgoing instrument was acknowledged before me
this aTH day of OCTOBER 20_ by
JEREMIAH JOHNSON
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
STATE OF FLORIDA
COUNTY OF ----
The forgoing instrument was acknowledged before me
this BTH day of OCTOBER . 20_ by
JEREMIAH JOHNSON
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
(Signature of Notary Public- Stad
o ,,, oq a
re of Notary Public- State
rxdygrF, hELISSAS.BOECKEL
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Commission No.FF'9%9�%S
misslon#FF979476
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17