HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-1/1-5/1.q -SCANNED Permit Number:
BY
'St. Lucie County
Building Permit Application
Planning and Development Services Pe
Building and Ede Regulation Division oun ent
2306 VirginiaA.4fiue, Fort Pieice FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578 Commercial Residential.''
PERMITTYPE: pDar
PROPOSED INPROVEMENT LOCATION:
Address: 3.�66 la&Li6w rl'lrle' Fy rleme Y
PropertyTax ID /qr�5 - 05_ 0onq -000-g. L6 I i , 'NO.'
Project Name: 1_01S&I;ftl 511 di q [)j9Cr rep&,4p7f4f ,
DET,AILED',DESCRIPtION,OF,WORk-.
7
CONSTRUCTION INFORMATION:' .'
Utilities: Sewer Septic Sq. Ft. of First Floor:
Cost of Construction: 600 total Sq. Ft of Construction:
.FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code, I that a - re in t I he
flOodolain:
Nonresidentia Farm Building- Ternp: Bldg./Shediused exclusively for construction
,Mobile/Modular for temp.'construction office:. Bldg. involved in distrib. of electricfty;_-
'Oth&: - Flood Zone: AFE: Hoodway? Y/N 77Y, -
Nok Rise Certificate with supporting data attached? Y/N.
All otherrap'plic6ble staihe�and,feder.61 permits,shall be obtained 'prior to commencement of
construction.
OWNER/LESSEE:,
C014TRACTOR:
Name— a ryn
Name: DeV1,67 W
Company-j�I�QSU �Ct7sk114� raw
Address: 1216 q lcjqlx�&� IllytS 6;,�
City: State:
Zip Code: 22101 Fax:
Phone No:
Address: !7 (D d"VIr MWO)
City: 1-1 J__j1'f V State:
Zip Code: Fax:
Phone N tl;2�. . -
E-Mail: K ,CI A I'm gfi� (RI 9*�d- Om,
.. . - 7 - � r.
Fill in fee simpleTitle HoldeIr on next page (if different
from the Owner listed above).
T _M_
E-Mail *nWjrPrfrX-h C P. 90)m!Z�
State e or County License r C706,9a qqq
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
'SUPPLEMENTAL CONSTRUCTION•LIEN LAWiNFORMATIONo-
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable.
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
.City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is herebv made to obtain a Dermit to do the work and installation as indirnted
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucieCounty makes no representation that is granting a permit will authorize the ppermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an -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 -
commencina work or recordine vour Notice of Commencement.
Signature of ner/Lessee/Contractor as; Agent for Owner
Signature ofG ntractor/LiLicense Holder -
STATE OF FLORIDA '
COUNTY OF S
STATE OF FLORIDA
S J
• Ltnc_: t
COUNTY OF - (iwt : C
The fo oing instruyent was acknowledged before me
t/h'i's! 'dalyof�!^�
The for oing instrument was acknowledged before me _
L ,20Lgby
this. day of 20-1J_ by -
i
( "
C 1 :
1 r~y a-i, .-� 5 tvi'� ✓'1 ..
.Name of erson making statement.
Name of p rson making statement. -
'Personally Known OR Produced Identification.
Personally Known OR Produced Identification•
Type of Identification
D
Type ofldentification-
Prod6ccei -
Produced
(Signature of Notdry Public- State of Florida) . -
(Signature of ota Public- State of Florida ): -
Commission No: �-'Q`1 i� (Seal)
Commission No. l-O f -7 � �' : " -(Seal) .. ,
;; 2,•,, COLLEEN SUE HAYES
REVIEW
"
Comm.
v ca„L6N9T1CF
sion N FF 200
"'
2a
'SU
RVISOR
PLANS
3'' Cinn
,JONAv
ni.ssion N FF ?09
2E
GROVE'.
' a
c 079
IEW
r'REVIEW ,
`,
arlZ�yi�5W201:9
R
IEW
DATE
RECEIVED
DATE
COMPLETED