HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAfl APPLtCABLE INFO MU T BE COMA =_.'ED FOR APPLICATION TO BE ACCEPTED n /j
Date: - q SCANNED Permit Number:
BY
,x �wxE ale Luce County
my
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
PERMIT APPLICATION FOR:
Address: k Oa^U
Legal Description:
Residential
es dential
Property Tax ID #: 0 �Iy . dCiU , Lot No.
Site Plan Name: Block No.�Z
Project Name: L&4D
Setbacks Front Back: Right Side: Left Side:
aitionai worK
✓Mechanical
er tnis permit — cnecK an that apDly:
Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� Q(� r Utilities: —Sewer _Septic
_ Windows/Doors
_ Roof
Building Height:
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Al
Nam
Name: CI- eA
Address:
Company: '
Address: A� - Z
City: State,
Zip Code:'-S-qq,57 , Fax:
City: State:
Phone No. 4(4(Q -
Zip Code: Fax:
E-Mail:
Phone No.
E-Mail: 1, '
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License:
a vawe or construction is csuu or more, a KECUKDED Notice of Commencement is required.
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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.
1 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 Commencement.
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida ).
Contractor/License Holder
STATE OF FL A
COUNTY OF L
The forgoing instr ent was acknowledged before me
this ZS day of 20�� by
(Name o person ackno ledging
of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known ✓O P o urp lrJPntif5ca 'otui
Type of Identification Produced Type of Identification Produc
�Fa3S3aZ ..
Commission No. (Seal) Commission No. �.r;' ���.� ri�a�Public -State of Florid
y o m. Expires Jul 22, 201
Commission # FF 038392
h4 n,N,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
LOC-MO YMIMMUIREEK:. _ Not Applicable
Name:
Address:
City State•
Zip: Phone: .._
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
— Not.Applicable
City State'
Zip: Phone:
BONDING COMPANY: —Not-Applicable
Name:
Address:
City:
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 ang covenants that may restrict or prohibit such -
structure. Please consult with your Home Owners Association and review your deed or 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
CA:Y11'YfPnririf7 wn�te n� in�nrA:Me.......� M..._�� ..1 r•____-.- _ -..._ ..
STATE OF FL
COUNTY OF
The forg�o,ing Instru ent was acknoo��wwledgt d ¢efore me
this'�(day of Zp by
(Name -of person acknow dging.)
State of Florida
Personally Known OR
Type of identification Produce,
Commission No. . = Notdry public - state
,cam `1 IMy Comm. ex Ju
,`'ti Commissionj# FF r
Signature of CoptardoirlUcenseHolder
STATE OF FL I!A
COUNTY OF](��
The forgoing ins r en a owledgo, efore me
this day of 2pA�by
(Name of person ackn (edging)
n
ature 0940tary Public- state of Florida )
Personally Known
`J r`,-w' + e Notaf� �P,u'Q le - State of Florida
-
4RWi ion No. My C I olres Jul 22, 2017
20f 7 F(= � ",�, F�;�.,• Commission # FF 038392
RE -VIEWS FRONT ZONING SUPERVISOR VEGETATION SEA TURTLE MANGROVE
►ATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
,ECEIVED
(ATE
OMPLETED
ev. 772011.4-
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S SNQ : WO�Id
Name:
Address:
City: State:
Zip: Phone: -
FEE SIMPLE TITLE HOWER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address: • __.
City. State•
Zip: _ ._ . Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIOVIT: 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 it granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Homo Owners Association rules, bylaws or an covenants that. may restrict or prohibit such -
structure. Please consult with your Home Owners Association and review your deed or 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 recordine vour Notice of Commencement_
Signature -Owner/ Agent/ Lessee
Signature of Co or/license Holder
STATE OF FL9MnA
COUNTY OF
��
STATE OF FLO� A
COUNTY OF .� le_
The forgoing instryment was a
this day of �,
cnowledged . efore me
Zp�by
The forgoing inst ent was a knowledged pafore me
this day of �_, -1 by
�
k
toA
cla�cp_J1
( e of person ack owledgmg)
(Name of person ack owledg ng
Signature Notary Public-
ER YNNE RUSE
Personally Known O � egfjf#A lo--6aate�af
e of Identification Produc » • 2
COMMis5ion No. . ,,,. Commission FF 099
spafl
tore o 4tary Public- Stat o 1=1ida�
" *p �
F o�l. Wally Known OR Pr '` f ati� iAIYNNE rl�' .
2 g of Identificationion Produced _ ,- I ryV M --six
�- `� ,
92 ��' •,, r Commission d FF 'J;+
lssion No. g Seal
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
RV 111117A
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