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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED } Date: — G1 SCANNED Permit Nu�� e 1 �i q7, zT l BY A �1019 • .St. Lucie County `I ��C,� mart Building Permit Application .ry 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 III Address: 0 Legal Description: S�ouI V i l 1p-S C@nrJLo rVN:(n wucwti 6-U_n; t -i(9 Property Tax ID it: SSa a - (.00 j - 0o -3 Fj - wo - X Lot No. Site Plan Name: (��," Block No. Project Name: P)9LV 6 _1-6U W0r-1CI-4,f Setbacks Front Back: Right Side: Left Side: L{'iS YLt� CoiO� Of I CONSTRUCTION INFORMATION:'_ _ Additional worto b[elerlormed un ert ispermit-checka apply: 13HVP Gas Tank ❑Gas Piping hutters ❑ Windows/Doors 11 Electric 0 Plumbing []Sprinklers 0 Generator Roof = Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ �,tQ� W S Ft. of First Floor: _ Util ities:cn Sewer O Septic Building Height: OWN ERAESSEE. CONTRACTOR: Name d'b6LVOL. 1xioY C'KI' ? Name: Nu Gait &(10.ttl Addre-ss:_�ti3y ©CQD�lI Qr` ff�l� Company: r1AQ$tP�taye �, 5L'LdP-- �'{"' Y City: AZA'i6,1A 1�2�C.� State: Ft-- Zip Code: ?J�q S Fax: Phone No. Address: U'9LO 5F SW?an,-t . Ope• _ City: 14D �-,e S6LLvtT State: Zip Code: 531-45S Fax: Sin 1' -3 Cio clef Phone No. S_CP (• _4I.0-Dcli' E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail: Y2{ ecc�@ Fl tY State or ount License: i_ O a S t If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. U#�PLE�y+tENTA GONSI/RiJCTIOPt LIEiV s1 AWb[pIV FORMA, � *fi g , ,.'a, '� i:a 1"?'w .n ha..i*° k 1£'.R<Vav a... °�.n 4..r i.•°} '• .6' �+ TI �° ., ..H..57 ;W Hrc DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: 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, 1 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 1*n5pecUQQ. If you intend to obtain financing, consult with lender n attorney before commencing rk ofrecoVing your Notice of Commencement. Signature of O er/ tsse d /Contractor as Agent for Owner Signatureafntrn a Holder STATE OF FLORIDA pp,� STATE OF FLC IDA ;��^� nn , " COUNTY OF YY� eJX D�k,� COUNTY OF ` aCh'1 bet'.L&KJ The forgoing instrument as acknowledged before me The fp�going instrument was acknowledged before me `�1 thi�sn dayof� fT 20� by this day ofT I 201a by Iv Cal CAD Q �Q1i2 1 I� l C-k rAPQ ?an., k H Name of person making statement Name of p rrss9n making statement Personally Known /\OR Produced Identification Personally Known /— OR Produced Identification Type of Identification Type of Identification Produce Produced (Sign re of ota P, ' �' eS,Tate of N bWd&0) 001( (Si atur f No u, 4 tote of Flc f17N 0000K Notary Public - State of Florida :. .: Commissi 075422 x°: ���=, Notary Public -State of FlJ �� •` Commission No. • • � yComm. IT125,2020 ?•: Commis 154 Commission No. &36fi4p My Comm. pires1ul25, ,•E r°. ecndedMrough Naticnal Nahry Assn. ;,, OF��o; Bonded through National Nctxry REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.g/2/17