HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `q SCANNED Permit Number: -
BY
St. Lucie County
Building Permit Application
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 ✓ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
ON I I THAT PT OF
Legal Description: TRACT T-I LYG DOF P RCEELSINC, AD2275 THRU279 AND LYG S OF
PARCEL 280 THRU 289 AND LYG W OF PARCELS 291 THRU 304
(3.84 AC - 167,270 SF) (AS PER PLAT DEDICATION DATED
1124/1970)
Property Tax ID#: YSaDL-goI - 1(421,5 -oCG -2 Lot No.
Site Plan Name: Me_kkk S 1—'���� p�ti Block No.
Project Name: 1V6i1cIGS ► A\cvt8 (�' �b V�OISS C
Setbacks Front (9 S r Back: aa-rj r Right Side: �' Left Side: aSS
DETAIL- , DESCRIPTION OF WORK:
�,G.Y"1�rxS 71wR�c�-8' OV-Lx' i-C�- �iGC%s'M2
CONSTRUCTION INFORMATION:
HVAC U Gas Tank
Piping
UElectric Q Plumbing 115prin
Total Sq. Ft of Construction: S6.
w
Cost of Construction: $ 9 `3+ C
Shutters Windows/Doors
Generator a Roof = Roof pitch
5 Ft. of First Floor: _
Utilities:Sewer [--]Se—
ptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CJ -docx' Q725pyk Of p4e-Wi45- -151
Name: X kal'1 '%zVPxf
Address: GfsG ) S C>CQC�.k
Company: C.-'R G n% P6
City: 7.e'g,:�� State:
Zip Code: 3y 9S'Fax: `-
Phone No.
Address: 31 al 5P-
City: Sbrpaj- State: 9-11.
Zip Code: 3n Fax: -3,)i -k 5 is
Phone No. `:
E-Mail: ---
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If valup of rnna.rr'rr;..� ;c doenn __
E-Mail: - . !2
State or County License: I (0 O Ci9
a r...,.,,r...Lu -wine ur cmnrnencement is required.
.y
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name:
City:
Zip:.
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Not Applicable
Name:
Nddress:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Phone: I Zip: Pho
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 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-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 orje�inp vour Notice of Commencement. �>
as Agent for Owner
STATE OF FLORIDA p "
COUNTY OF ti t��(t�F,
The f oing instru ant was acknowledge before me
this, day of , 20M by
Vrl �e-oN►I/
Na a of person making statement
Personally Known OR Produced Identification
Type of Identificglion _
Signafur-e—of Contractor/Li ,ense Holder
STATE OF FLORIDA
COUNTY OF
The f oing instru ant was acknowledge before me
this dray of t 1 20V by
t�N m of p� w'—:�� ant ✓
Personally Known OR Produced Identification
Type of Identif cG 4ion ,
(Signature of Notary
Public- State of Florida)
(Signature of Notary.Public= State of Florida )
KARE I&)NIELSEN
%� -Srate
Commission No.
Commission No. KAR NIELSEN
;: of Florida -Notary Public
= ;gig Commission # GG 207464
`o`"" " State of Florida -Notary Public
P bli
-,?.,o„�a�°•.• My Commission Expires
_.Commission # GG 2y
y
�����i
i•�`o•` June
2, 2022
O N I G
REVIEWS
FRONT
PLAN
VEGETATI
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
Rev.