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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^, - Date: SCANNED Permit Number: 'q� �' ��/yJ -- — - BY c St. Lucie County RECEIVED Building, Permit AppliCation JAN 15101% Planning and Development Services oeparunent Building and Code Regulation Division per i n county , 2300 Virginia Avenue, Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1579 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PR®PQSED�%11ViP�0UEl1[IENjT Lil�ArfiyQfll'�� ' ,. � _ _ _ Address: _:00 5. U!5 l�Zt/l�✓ A Legal Description: Property Tax ID #: Lot No. Site Plan Name: Block No. Project Name: &amok 11'At:T Staia Setbacks Front Back: Right Side: Left Side: DETAI EEU ©ESCRI,PTION ' /,�S%fJ'LL. 7liLGrcti Gd�ralL�nG �� �/C�ti1 Q7�V ��-l. nuumvgQJVVViALUu mwnucu uuuciuuapcnnu—umui.au i. apply: OF _ Gas Tank ❑Gas Piping _ Shutters Windows/Doors B�Electric OPlumbing Sprinklers Generator ❑Roof Roof pitch Total Sq.'Ft of Construction: S . Ft. of First Floor: Cost of Construction: $. f- 104 Utilities: Sewed�'�_1 Septic Building Height: /U r t®VUN-ER%L�SSE�_ R'y' 'rC20NiRL1OR `a ,..K — ,d figs . _ ,L. e ..5'SSMFc, Name -rwi " aTm 100 A4 e— Name:. 19#&""� Address:S 2. ,a-1zr2�� Ap Company: 1&r co City: ' q' State: w Address: 3/S'" Zip Code: 10 Q 2 Fax: '110 92rZ V 1 o �I�V City: '% //At4b State: Phone No.11a 9Sd It 10 Zip Code: 53311 Fax: R3 Z73(a E-Mail:zgV15 106-1-A-0 S1&05- &°aci t Phone No. &YJf 2011 Fill in fee simple Title Holder on next: page (if different E-Mail: 123 a zIYi '!--- from the Owner listed above) State or County License: 65hp-O&V!$ S If value of construction is $2500 or more, .a -RECORDED Notice of Commencement Is required SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Ap(i1Jlicabie MORTGAGE COMPANY: K Not Applicable Name: C44ia.iy %9atbLLt! / 6A6LI SEA46 Name: Address: i2co P(-wlw� T Address: City: 33o Ct4 G:++ to State: F� City: State: Zip: 3343-J- Phone 570f Z'4t, 37 i i x 3 Zip: Phone: FEE SIMPLE TITLEHOLDER: A Not Applicable BONDING COMPANY: ti Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto do the work and installation as indicated. I certifythat 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 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-resldential. use WARNING TO OWNER: Your failure to Record a Notice of Commencement mayresult 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 our Not!jQeof Commencement. Signature of Owner/ Less /Contractor as Agen or Owner Signature of Contractors a Ho der STATE"OF FLOMA Yq STATE OF FLORIDA COUNTY OF i COUNTY OF The forgoing instrumen was acknowledged before me The fo oIng instrull�t was acknowledgelId}}��efore me 7dayof L this day of_ 120/P by this JP by Ala Warne of person making stathment ✓ Name of person making statement `L Personally Known OR Produced Identification Personally Known OR Produced Identification Type ofidentific Con �fhD/ Type of Identification Z 3�9/�%/ Produ//ced�� Produced M-.'� iL i� O �l �MGPPS�aO atS9�g4 s (Signs u (Sig tune of Notary Public- oNdal vo xo o so , ova ass as s Cornof Pennsylvania- NoIf tary Seal Commissi nNo. DEIDRA L BERRY• Notary PublfSeal). 11j/, N Commission No. o•;;.'�?'- .co m,9N,�- Ld °` M(05ad0°`°to My Commission Expires Oct 2, 2022 N' Commission Number 1237439 1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION RTLE MANGROVE COUNTER REVIEW REVIEW. REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 I1