HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONC"
ALL APPLICABLE INFO MUST BE'CvmPLETED FOR APPLICATION TO BE AccEr-1 ed f "
Date: SCANN Permit Number.
Rm
'•f�t]Nf
L":iC7MR
ED
BY
St. Lucie County
Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
230D Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_
RECEIVED
n
JAN 04 2019
ST. Lucie County, Permitting
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line a� III
PROPOSED IMPROVEMENT LOCATION: III
Address: 12I., o 5. OCeA,v iDr. �jeA se j 6en�h F7.
Legal Description:
Property Tax ID #:
Front
Right
Lot No.
DETAILED DESCRIPTION OF WORK: III
R6ore e4i'Aw, -Q)oco 4,D Ce, iwD t., v,v vjs ckoors 04 900M.
A4101 C 6C wFll oipe fj,WS C�Pw.y3a(()• j/,,pj,4
wCnidowsa.•vd 01000, �r�wc\\J�l ini ,ro,n� 5'�Vcc.0 4-0 ma�c�e�{,S�in�y eF�c✓ice
CONSTRUCTION INFORMATION: "III
0HVAC Gas Tank ❑Gas Piping _Shutters• I.L.1 Windows/Doors
Electric Plumbing Sprinklers Geneltor El Roof Roof pitch
Total Sq. Ft of Construction: A, �4 S . Ft. of First floor: A11A
Cost of Construction: $ '�7T�00. 019 Utilities: 0Sewer 560c Bullding Height:
OWNER/LESSEE:
CONTRACTQR:
Name LkrrNm, ln.A 5 Cn=d 0
Name:
Address: _I1e0 S• OCe,4_,v adt^•
Company: Cmvr
Address Gt 1'NO�
City: .Ta,v.se-'i ACCnjc� State:,
Zip Code: 3 '1 q 57 -7 Fax:
City: Stater
Phone No. 77a^22,9- 9117�
ZipCoc!M 3 9Fax:
PhOne,No77.2-a1<11-3/35-
E-Mail:_'w:nlyp-jANIY'L%00✓✓)
Fill in fee simple Title Holder on next page (if different
E-M�{I; h pyavrl rr 1�e �s �v�oe✓, t0 �i
from the Owner listed above)
State or County Ucense: s.BC DS Fs'7 ��
If value of construction Is $2500 or more, a RECORDED Notice of Commencement Is requirtV.
SUPPLENIEN�AL
GONSTR•
ION�i.IEN�i.AW
INFORNfAT10N
°` ." X � _,. � �,� � � � �
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Not Applicable
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Zip: Phone:
Address:
City:
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 anv applicable Homeowners 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-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 inti'_nd kit obtain financing, consult with lender or an attorney before
cornmencine work or recording Your Notice of Commencement.
Signature of Owner/ essee/Contractor as Agent for Owner
5g—naturi of Contractor/Ucen older
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF �T, 1-06N
COUNTYOF M./(
The for oing instrume was acknowledged before me
The fo ing instrument was acknowledged before me
thisTdayof�nJrMill%1 20/`f by
this "day of JAW, 20JJ by
)(wJ- ti 'e__ax4d^1 ;' I/
i"E& -t -I I l'F'lg26r
Name of persqvi making statement
,
Name of pzrson making statement J
i
Personally Known OR Produced Identification
Personally Known"' • OR Produced Identification
Type of Identification
Type of Identification f
Produced
Produced I L T) L
r,,
(Signa a)
(Signa re of to u ITC ate of Florida)
;oi✓s �o<L. RUSSELL FRANCISKEARNEY
COm Nota Public -State of Florida )
Notary eal
Commission No. �_ iP ", FRf�y�,�1OU1511
"9 "�. No�yl�?�@a6k'Ee=soe a
�=hi 393
My Comm. Expires Oct 30, 2022
.� ��• Cann'saC^.kGG 149945
My Con, ExoresCa9. 2021
5
"�"OCRi .T.�•M1iAM21 FCbYAiY.
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COMPLETED
Rev. 8/2/17