HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEE
Date: 1 — I r Permit Number:
SCANNEDBY
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' c St. Lucie County
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--- - Building Permit Appl cationpEC 4 2ois
Planning and Development Services Permitting De artment
Building and Code Regulation Division g p
2300Virginia Avenue, Fort Pierce tL34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:_.
Address:
Legal Description:
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W a,Fy 5S ( lo.6o 4C ) C b Z 2 f 52 i? 5z
Property Tax ID #: l y2 ' 3 23— OU m 2. ' DOO - 2. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _Gas Tank "°_Gas Piping _Shutters —Windows/Doors
_ Electric —Plumbing = ,! `
umbing _ Sprinklers _ Generator _ Roof Pitch
tTotal Sq. Ft of Construction:, &5(. Sq. Ft. of First Floor: JOW 6
Cost of Construction: $ C, �y '� '� Utilities: —Sewer _Septic Building Height:
OWNER/LESS,EE: #,
CONTRACTOR: w,
Name �'t(1�� f ►V1r1 :Qa �.
Name: QoVA
Address: 1.1
Company:
t✓lr
City: (;Aryl CAnd State: $&
Zip Code: cSabO 4 Fax:
Phone No.
Address: 7
City: v;A— IZ�X-tck— State:�L_
Zip Code: RA rG��'�.T Fax:
Phone No nrl [ r LAI
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
``.
State or County License 15
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTiL CONSTRUCTION'a, LIEN LAW INORMATIQN.
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5.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not`Applicable
Name:
_
Name:
Address:�j n
Address:
City:',• '" "='' "°°` ` ' State:
City:
State:
Zip: Phone
Zip: Phone:
c, t rn ;
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Not Applicable
Name: .~ ;'I:"'=''
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 adt.)orize;the perinit holdento build the subject;structure
which is in conflict with. any applicable Home Owners Associatiojl,tules, bylaw! arSd,coyeriants that may restrict'or prohibit such
inconsicieratien of the granting of this requestep permit, I oo herebyagree`thatcwill, in-alrrespetts; perfotm•the work
in accordance wd the approved plans~;IiFlori da Building Codes andlSt Lu ie CountyAmendrnerats. �) }`?i's: ` J
The following building permit applications are exerppt from•undergoing a full.concurrency review:,ro )m additions,
accessory structures, swimming pools, fences, walls, sigris, 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
beforq the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comnyencine work or recordineAour Notice of Commencement.
S' ure of 0per/ LesseeVC ttactor ash gent for Ownerv. .3_
_Sign'at r of Con{{}}actor/Lic nse Holder,(: i., j
.
STATE OF FLORI A4L -. }
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STA E OF>FLQRlDA i ' i '. `< 1 - r
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COUNTY OF r `F i(a E `: (j "� C'�
COUNTOF illYetuLtE ._
The forgoing instru ent w s acknowledged before me
The forgoing instrument w s acknowledged.before me
this /4 day of Etewr 20 N by
this /4 day of At6Ntt� 20� by
1/®y1 Al 4<.s14,4�1
�/o„ /
wr e4w-C4 -d
(Name of person acknowledging)
(Name of person
y�
acknowledging)
(Signature of Notary Public -State of Florida )
(Signature of Notary Public -State of Florida )
Personally Known _ /FOR Produced Identification
Personally Known _ ,,-"OR Produced Identification
Type of Identification
Type of Identification
Produced" _I _ . t',
Produced r.
Corr rtlssion,No. �, F' ,_ �`(Seai) I:�
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REVIEWS
FRONT
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PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER ._
, REVIEW..
--` REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
-RECIVEDJ:.}s
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DATE • ;'� I_7
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COMPLETED