HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C° Permit Number:
�.� SCANNED
oV
RECEIVED
® Dien AYAppl1cation 2 8 ?019
BuiIding JUN
Planning and Development Services permlttin
ST. LNSIo Cou ty, 9
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 Xz5
PROPOSED IMPROVEMENT LOCATIONt
Address: -_t{I z "l L� 0 l LY Cb VP- by IV• P -
Legal Description:
Property Tax ID #: J4cQ5 70 i )-b 4 0-1 5 —7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED'DES(fRIPTION OF WORK*-'
1nSi-o,'A INS Nm) IMp9j2:i- lt)Ind 0W L
Ins-t0-u(,-) OAD sltdln5 CJ doo►r5, r�dN trnpac+ �41o�
h E 1�sa-
CONSTRUCTION INFORMATION;
Additional worR to orme un ert ispermt-c ec all ply:
❑HVAC e e Gas Tank ❑Gas Piping _Shutters Windows/Doors
�j
Electric Plumbing OSprinklers 13 Generator I J Roof Roof pitch
Total Sq. Ft of Construction: Sq� Ft. of First Floor:
rr t 11 11
Cost of Construction: $ J Wa • `19 Utilities: LJ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: '-
Name 6 V <
Name:
Address: 0L} aYbau� 'n
Company:
Address:
City: —i I ) I i�12 Q State:
Zip Code:
City: State:�L
1_1 CC��Faax�:
Phone No. � rQ L{ O/"l � 558Z5
7
Zip Code: '7 %0%1 Fax: "^ 1
E-Mail:
Phone No- `no
Smsdg-("�
Fill in fee simple Title Holder on next page (if different
E-Mail: _
G Q
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
5
,SUP.PLEIVIENTAL'CONSTR_UCTION LIEN'LAW`INFO,RMATION:
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: _ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby maoeto obtain a Perrin to UU err= W� _ -- •••-•-- --
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 resu n your paying twice for
improvements to y9dFrproperty. otice of Commencement must be recorde an poste the jobsite
before the first ins ect on. Ify u in end to obtain financinng,QconsuJt' I len r o an at me before
commencln wor or r cor n vu IMULIUC Ur
_
Signature of 0 er/ Lessee/Contractor a Age t for Owner
Signature of Con ctor/License Mcilder
STATE OFF RIDA
STATE OF FL IDA
COUNTY O 0rC112.gp
COUNTYOF cr
The forgoing in rument was acknowledged efore me
LY
The forgoing' strument was acknowledged before me
this Qg da of 20 [Iby
this —'2C-)da o �— 2l1
��
Name of person making statement
Personally Known V_ OR Produced Identificati
Name of person making statement
Personally Known /— OR Produced IdenY tion _
Type of Identification
Type of Identification
Produced
Produced
(( II
LW
Signature of Nota I'c- a f Ir'
( ignature of Nc. ary Public- S a e of F
on Nola Public Stale da
,,xr e ry ($Ifil�
"I °err Notary Public Stale of F. da`
Commissio NB 4 • aboni Nall)
Commission J01, iccabom
Mycommission FF 981647
My Commission FF 981647
+7 EzPireso6/2812020
:•" _ a`O Ez ues 0628/2020
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REVIEWS
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SUPERVISOR
PLANS
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MANGROVE
REVIEW
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DATE
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DATE
COMPLETED
Rev.8/2/17