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HomeMy WebLinkAboutSUBMITTED PAPERSAll APPLICABLE INFO MUST BE COMP"­t'.D FOR APPLICATION TO BE ACCEPTED Date: 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: ©� c\_Q_ A C W Address:��— Legal Description: 3 y 2 5 O 3 C3 Z4 2 0 ODn Property Tax ID #: Lot No.Z Site Plan Name: Block No. 2S Project Name: Setbacks Front Back: Right Side: _ Left Side: /J S acL Q 5 x 5 LA 1'A. s- 13C)b 1�c (2/Z- /'►ESN Y �K I�r%Uau) a.� ��2 faor c Aciclitl nal work to be performed un ert Is permit —checka tat apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: xi 2 s Sq. Ft. of First Floor: Cost of Construction}.$ 0c7 Utilities: _Sewer _Septic Building Height: Name IJ i!' :ct 11 'WG`BR Name:-, 0S2 Address: `5a C. i Compariy:�_ ' Q �G e Q c i City: PS G State: - '; 1 'Address:'' Zip Code: Fax: 2 3 SA3O } 6y City: S L State: Phone No. 7 TZ S, Zip Code: 3 g 4 g 6 Fax: 7 21 3 u&� E-Mail: Phone No 7 7 2 9 12— S Fill in fee simple Title Holder on next page (if different E-Mail Jn4 6 eohlcX e, rAg State or County License K a.`t, from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Address: I Address: City: I City:_ Zip: Phone: I 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 vour Notice of Commencement. Signatu er/ Agent/ Lessee/Contractor SignatuMAf Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDt COUNTY OF. �# s ,� COUNTY OF �` The forgoing ins ument was acknowledged before me The forgoing ins ument was acknowledged before me this � day of � 20- by this _8 day of n��m.t 20_1� by (Name of person acknowledging) (Name of person acknowledging) (Signature of of Notary Public-S to of Florida) (Signature of Notary Public-.Stale.of Florida ) Personally Known _ r) , OR Produced IdentificatioA� Personally Known OR Produced IdentificationIEL-M Type of Ide�1 -tification Produced 1 �lr�• al •`l r Type of I entification roduced �, 1• },yam LASHAHNAINGRAM '• `�-'--MIY .'�•, LASHAHNAINGHAM 15Y COMMISSION# EE 050558 Commission NO.E:4SOSS�2 (9eatJ:S: December 20, 2014 COMMISSION# EE 050558 'T EXPIRES: Decemtier20,2014 OmmI5510n No. el. 0`�rr„fl Bona'I otary Public UndeiwrAen 'd;nCetl Thru N4laryPubfw Undervrtiters REVIEWS, FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED ' DATE COMPLETED ev. i L C11UN WE -�i A;N CAUTIOW N ootml THEI FROIT-IA of, "IftlWA 01*VOR R"aaCCHptt3d t ,16..14111, a"this tlbxai I ' and..graa I h term acA 14tio6t. 4 IAM w. 0.0 wwRm DF STU PPPDLKMA' T D,9L0CVCZL-, U0Tq0a;ascT u29=UO3 USOP We 60 STOZ'ST 'U'2.0 PLANNING & DEVELOPMENT SERVICES DEPARTMENT Building & Code Regulations Division 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772) 462-1553 FILLED LAND AFFIDAVIT /cir 1 Z. - O ©ZG I, the undersigned, am the owner of the following described property, FOS G (Parcel Id#/Legal e/.eC4E, L/JC/EI FL for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number , I acknowledge that as owner of the above described property, and in accordance with Section 7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring adequate drainage so that the immediate community WILL NOT be adversely affected. I further acknowledge that in granting this permit for the development of this property, St. Lucie County is neither obliged nor liable to provide for, or maintain in any form, adequate drainage off my property which will not adversely affect the immediate community. DAn116L LE.AX10A) I Prope caner Name (Please Print) /-845 -Property OwnerSignaft re Date STATE OF FLORIDA, COUNTY OF SAIAJ'r LUClE ACKNOWLEDGED BEFORE ME THIS O DAY OF 20/3- BY D� � WHO IS PER S�ALIgY=KNO ft E (� OR WHO HAS PRODUCED p AS IDENTIFICATION. SSIIGrNATURE OF NOTARY PUBLI , TYPIi (SRPRBi7' NOTARY FCJG /I?V COMMISSIONNUMBER � .. ' --�, ELLEN L. ROULETTE - �; Notary Public -State of Florida �: •= W' My Comm. Expires Sep 25, 2015 '/ c SLCPDSD Revised 04/112011 Commission # EE 101180 Bonded Through National Notary Assn.