HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —0-3119,
Permit Number:
SCANNED
0
@� , . M910
�f�
BY
St. Lucie County
RECEIV—ED
Building Permit Application
Planning and Development Services NUV 1 0
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 �T. Lucie County,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial r/ Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
I PROPOSED] M PROVEM ENT LOCATION:'
I
Address: �) 661 .4-). !=L ��qk
Legal Description: U�Oi "PWA- �)Nc-r J<a5-
Property Tax ID #: 191Y. Lot No.
Site Plan Name:
Project Name: R,8Y1V OC-054AI 7,_9k."Z.-td_S B,,1zy;Ae_ A
Setbacks Front Back: — Right Side: LeftSide: -
[DETAILED DESCRIPTION OFW6R'k:
Block No.
1:--C% 0 N Sfk"U C'ZT-1
O__ N � I N FO R MATI 0 N
Additional work to De
rtormed under this permit- check all
apply:
Gas Tank DGas Piping
Shutters E]Windows/Doors
electric
El Plumbing 05prinklers L1
Generator EJ Roof = Roof pitch
Total Sq. Ft of Construction: ZZ) g�,k-r ScLFWtoe First Floor: 11004.r-r
)> S
Cost of Construction: $ C19_007RV Utilitie —Sewer E Septic Building Height:
OWNER/L`E�SEE'.,
C 6 N'T R A C-,T,,O,, R_
Name I C
Name: il ftazy 0 .
Woe- ic
Address: !Y C61 W - I+LJY
Company: R.4,vKeW5
e..ZkA5P0eT';Ad3 eZ--
City: --- ) )SLaA�-D state:
ZipCode: 34'q�-e Fax:
PhoneNo.
Address: 4)AR /,;?7rJf/
-.5r-,
City: P9;e-,.
zipCode: 3c29&O
Phone No. 6q3-52OR
State:ZZ.
Fax:
E-Mail; Nvg Vr 6vt o-�,,T'A Q
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
E-Mail; Pp;vA46Rt�)oLF(@
State or County License: CK.-le
O�M42_pg
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTROCTION LIEN LAW INFORMATION:
DESIGN ER/ENGI NEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: r--A,i-utE
Address: Address: MkL5c,
City: State:. City: if uf'—Ujoc'�J State: \1 ft
Zip: Phone zip: -V, I 7e-'> Phone:
FEE SIMPLE TITLEHOLDER: _NotApplicable BONDING COMPANY: —Not Applicable
Address:
City: city:_
Zip: Phone: Zip: Phone:
.')WNFR/ rnNTRArTnR AFFInVIT- i� h.r.h,, �.H.tnnht.i. . �.rn,ittn dn thpwnrk and in0allation 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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 Owner/ Lessee/Confractor as Agent for Owner
_510;irture of Contractor/License old
STATE OF FLORIDA
STATE OF F�OIRIDA 4�
COUNTY OF S4. Zme"a
COUNTY 01
The fo oing instrument was acknowledged before me
Th f ' ' t Oint was acknowledgetilbefore me
e or
this 12 day of Aley 20Z& by
this day of \1 , 20_L.Z$ by
i1I4,CJ,ct,eJ &-^ -:J_f
n
I kmk_x� Wn � r- I
Name of person making statement
—Name of person making statement
Personally Known >C OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced t\
(Signature of Nota P. glow "r-nSnt&'6te of FkKWI
(Signature of Nota public- Stare of Florida-1
Com I # IT 930M
Commission No.. C o mT! VC, 2010
If Ire& Del 26.2010
LS
KARIN N E N
Commission No. I Pu bI1
801 F �r' �014 "ry
W
BoMthrotORWwWW"AssrL
commission G 2074 4
My C07� , ss'o Exp, re 5
17 .2n2 2
REVIEWS
FRONT
ZONING
SUPERVISOR
4NS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
R �IEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
4�
COMPLETED
Rev. 8/2/17