HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA& 7-
All APPLICAB E INFO MUST BE WMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I a al I i0 Permit Number: I O I
SCANNED
C/
- St. Lucie County RECEIVED
w
_ Building Permit Application 'DEC 3 0 2096
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucre County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
V/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: SH��
PROPOSED INPROUE'MENT LO ATION:
Address: 45-55 so��1� v�t��gr! �vQ2 �(L• Fi ie,R2, 3 CLJ9Wk
Legal Description: ?,G 35 AD klwk r'04& of N 91.8(al u� S lSo 7,oa7 O-C Gov+. LOT �
Lys Eon V4-C QtZ wvky- 919 Rv\\,Ns-less SZD F4W (,SaAQoa- 35aSr-a497
PropertyTaxlD#: aLi3(o Sac{ eDOO& 000a�_ Lot No.
Site Plan Name: �— Block No.
Project Name:
Setbacks Front a S Back: S Right Side: 10 Left Side: 10
DETAIL=D DG IPTIO O ORK:
13
CONST UCTIO NFOR 10
MITOMi-MrK to a pet orme un er tit t-cilec a tat app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _,UVindows/Doois'
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction- pSoo Sq. Ft. of First. Floor: ti
Cost of Construction: $ / �� Utilities: Sewer Septic Building Height:
_ _
OWNER/LESSE CONTRACTOR:
�i obe¢V
Name rw a✓\2j10 Name:
Address: 38G N C AW e 'Company; l
City: �Poa:� State: Vl -- Addres`s:-
Zip Code: 34 117 a Fax: City: / State:_
Phone No. q S-9 341 OS 96 Zip Code: Fax:
E-Mail: 9-O6 Sa.v o-,-eAVo @ o rn c�,\ .Co »-N Phone No
Fill in fee simple Title Holder on next page (if different E-Mail '
from the Owner listed above) State or County License
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
S III P.P.LE M -NI 01010_, SITIR.UCT O LIE LA NWINFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: - State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Zip
Not Applicable I BONDING COMPANY: _Not Applicable
Name:_
Address:
Zip:
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
rnmmonrinp gun le nr rornrrlinp vnur Nntire of Commencement.
Signature of Ow er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF tl�Cl i
COUNTY OF
The f ing inst ment was acknowledged before me
The forgoing instrument was ackno dged before me
this day of 20_[/'�q by
this _ day of 20_ by
L
(Name of person acknowledging)
(Name of person ack wledging )
(Signature of Notary -Public- State of Florida )
(Signat 71of Notary Public -State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ide tif' ation
Type of Identification
Produced L' KAREN S. NIEL
o, •^=
d
- Commission 8 FF 1
5037
Commission No. -Sal)My Commission E
p0001 sion No. (Seal)
June 12. 2018
REVIEWS
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ZONING
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REVIEW
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DATE
lg1_17
RECEIVED
1 L
DATE
COMPLETED
Rev. i/ZU14 /