HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I I- I z- 2011? - Permit Number:
Building Permit Appl
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 1z
CEIVED
NOV 16 2018
Permitting Department
te§�,ekygie County, FL
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address:
Legal Description: Sa PA-whe'Ju
Property Tax I D #: '� LJ Sn 1. UA I C) LJ()C)_q Lot No.
Site Plan Name: Block No.
Project Name: 0-)Ln- L na;c� [AW4 iw, Oetlywz��->
Setbacks Front -Back: _ Right Side: Left Side
C) oe / 'q
HVAC L_J GasTank
Electric El Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 11 q 6-1), (5D
SCANNED
BY
St- Lucie County
Piping U S'hut'ters E]Windows/Doors
nklers 1:1 Generator 11 Roof = Roof pitch
S Ft. of First Floor:
Utilitiest Sewer []Septic
Building Height:
[OWNERI/A � _. —
=
Name Mnrtdo -)op F?, L
Name: 7ccc- I
,1 L , W,_
Address: L 1.g
Company: 36') Lazg� _�A'qfts
City: - kr) lf\<� Q ir\ o'c' 1'�' StatY.
ZipCode: Fax:
Phone No.
Address: b" QM00154
City: L PpSh ic�; — State:_E�_
Zip Code: "?)W) V q Fax:
Phone No.,�5a-91D�\ - LjdS(D
E-Mail: -
Fill in fee simple Title.Holder on next page (if different
from the Owner listed above)
E-Mail: Oe'N\ AA -,Al 6D ' b . CIn All
'L8,
State or �ounty Licen-sie: e-stil wnz,6()
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ;� qS9 &I
.�5121 RPLEM E NTAL�100 NSTRUCATI ON�Ll ENIAMI N FORMA I TIOM,-o, J." M AM *1
DESIGNER/ENGINEER:
Name: hQl6_V_ aAS0%1k)
Not Applicable
MORTGAGE COMPANY:
Name:
Y'Not Applicable
Address:
IL,0-6 SU)
P(C?,(_�(,
Address:
City: "kt CJu
Zip: _'Mca Phone :?) &9-9
State: FC_
5Y- Sq /If
City:
Zip: _ Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
V� Not Applicable
BONDING COMPANY: �:�ot
Name:
Applicable
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 Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 171ict with any applicable Home Owners Association rules, bylaws or ancl 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 Owner/ Lessee/Contractor as Agent for Owner
_qgn6ture of ractor/License Holder
STATE OF FLORIDA
LO
ST OrDA
AT 9
COUNTY OF
C 0) OF —GJ4.9-
The forgoing instrument was acknowledged before me
The f Ing instrument was acknowledged before me
this ory
day IWILej�. 20 19 by
this — day of . 20_ by
of
c( -L't (�
Name of person making statement
Na ne of persop�aking statement
Personally Known OR Produced Identification
Personally Known V OR Produced Ideno2qon
_
Type of Identification
Type of Identification
Produced
Produced A'Al" ;- R
d�
4011%e
-A m 0 U) Z
04 S, 4 g --� 9
(Signature of Notary Public- State of Florida I
na
'/(S 'ture of Notkiy_Pu)blic- Stafe—of Flori m
Commission No. (Seal)
Ir mission No. 00 00 1 oa�
;o ?5
P
REVIEWS
FRONT
ZONING
SUPERVISOR
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVI EW
REVIEW
R E
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
8P_'rri,X('L + -#-- J� I I - 0 3 � 3
C
UP
1110 *110 0 V1 XL4 0 10 10 14 4;
OR AGECOMPANY: b"Not Applicable
EM
Name:
Address:
UILY; State:
Zip: 3A09, .4 P13ne
T(-( 17
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER:
1.11, Not Applicable
BONDING COMPANY:
Name:
Name;
Address:
dty:
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 priorto the Issuance of a permit.
St. Lucie Count makes no representation that Is grantlnga ermit will authorize the ermit holder to build h bj
which Is In conxict with any applicable Home Owners Assocrztlon rules, bylaws or angcovenants that may retsterictore rohlbItISU
structure. Please consult with your Home Owners Association and review your deed for any restrictions whicl may I (D
the w: 6)
In consideration of the granting of this requested permit, I do hereby agree that I will, In all respects, perform C-V
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. . 3
The following building permit applications are exempt from undergoing a full concurrency review: room additions, r_
C:
accessory structures, swimming pools, fences, walls, signs, screen roams and accessory uses to another non-resIdentl ta :3
WARNING TO OWNER: Your failure to Record a Notice of Commenc to
It In your paying tw e or
Improvements to your property. A Notice of Commencement mu=tracaoydr:'dUand posted on the liw
before the first inspection. If you Intend to obtain financing, consult with lender or an attorney bef r
commencing work or recording vour Notice of Commencement. ;-I
0
Signature of 0 ef/Lessee/Contractor as Age
forOwner L_-Sfgd-tureof
ractor/Llcense Holder
r
ZORID
STIA LORI�A
LOI
V0_
CO F
E6 f OF
The for ng Instrurnent wasaCKnowiedged before me
Rfflldlayof MU-QA%�r
The for oing Instrument was acknowledged before me
thl day M(Wf4�a4:&C 20J R. by
this by
of
C(
almof 3 akln� statemen
Nateof erson akingstatement
Personally Known'z!�CR Produced IdentIficat
Personally Known OR Produced [del on
'1 0
Type of Identification
Type of Identification
Produced
Produced
oil
zq
A
n 0 '<,:3�
( f I
Slg�ature of Notary�ubllc- State of Florida
IS nature o! Notwublic-State of Florlfj a 0'
Commission No. C�61 0o 0 (Seal)
C,
r _;1
. mission No (i 00 (dQ
REVIEWS
FRONT
ZONING
SUPERVISOR
P
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
R IE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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