HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONni
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date:3111% JQCA0 SCANNED Permit Number: `03'43�ro
BY
�x St. Lucie County
Building Permit ApplicationLM
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
(RQPOSEDJMPROVEMILOCATION: & "0'P
Address: al60 5.F- - MGri me a Ave, 1
Legal Description: 5T LvG(c C wA,?ns 10 A7 HO 'RLK Li see Alf"," �
Property Tax ID#:_i?!ic}IL4- 1501 - 5M I-Doiri -to Lot No. _i
I Site Plan Name: L %k' -CA rRenTw le, Block No. 4_
Project Name: L)f%i+ed Acn6ls q1re-s5ure Clea„ar
Setbacks Front4c Back: '90 Right Side: '%a LeftSider_
DETAILED DESCRIPTIONOF WORD o
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) A1 - G *Ho �TG� Pks Lo," Galt, -P'p;•,�
4'O L.P.VicvA a% L,-c`-er !praSSure t�ziwt;lljer
rtiona war to eve orme un er t is permit- crec a apply:
OHVAC L,�J Gas Tank ZGas Piping _ Shutters Q Windows/Doors
Electric OPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 145�O Utilities: Sewer Septic Building Height:
OWNER/LESSEE:' q.
CONTRACTOR:
Name two rntcal�:k � lc c d
Name: C6e&g4-nrr I rz111So s N
Address:_a�s-(� 3c I` px"N
Compar.. �-- r _k 1 -
City: 1�rT [A LSJLlQ-- State:
Zip Code: 3(40i = r' Fax:
Phone No.
Address: ,21 So 'PoA'%o. 'by-.
City: '?u)M e: A-� StateA->
Zip Code: 34AQ n Fax:
Phone No. (')7:t) :?GQ-C(Lo-1 S
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: IC rvt c.i n 1'o SL, Icl;+r
State or County License: 3 Rl
It value or construction is SZSOU or more, a RECORDED Notice of commencement is required.
SUPPLEMEdTAI. OSTRUC10EV W IN 0 RMQTIOPI
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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 or recording your Notice of CnmmPnrPmPnt
------------////�J(//
Sign�f Ow er/ Lessee/Contractor as Agent for Owner
Signat a of Con actor icense Holder
STATE OF FLORIDA
COUNTY OF f1/fj2vHk
STATE OF FLORIDA
COUNTY OF ajfb.1!
The for oing instrume t was acknowledged before me
this j� day of rex 20-0 by
The forgoing instrument was acknowledged before me
this _a day of March . 20-& by
GAGNGhh{ JOµ-
cAey"ne -E So"-
' ame of person making statement
Personally Known OR Produced Identification
Type of Identification
Name of perso aking statement
Personally Known=OR Produced Identification
Type of Identification
Produced
Produced
(Sig ature of Not Public- State of FI
(Signature of Notary Public- State o Floridaa I
Commission No.t;�eZ$3 a Notary PublicMcnpgf,t•Jpp"io
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g My Commission
9a Expires 12/11Q
G 293399 +� as My Commission GG 2
2 4Expires 12/1112022
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TU7RTLEMANGROVE
REVIEEVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17