HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED 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: To Select from dropbox, click arrow at the end of line I
Address: 40 k O a C fa L.'% S �SQX\31 .
Legal Description: L,11 sa xia \6 'p► oo L RA"'C1y V kill Lol opt
PropertyTaxlD#:�Sq-.1.0• /o,64 •Oda ..- doa- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front.. Back: Right Side: Left Side:
.NURc. C hAougc ouT LILLE L,iY-R- .0
to �_Yv —; o 3J cn. -V1 ;;Lz
Haaitionai worKto ne ertormea unaerthis permit - check all apply:
IX HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator F-] Roof
Total Sq. Ft of Construction: . S - Ft. of First Floor:
Cost of Construction: $ I (=q& Utilities Ft
0Septic Building Height:_
Name_J,3oR_rrN Ai f' S GP_F_w_1Z.
game:
Address_,01 NA-TIAt_1L_ DiP),
CompanytLPAm. Ail I&A Nal.o.5
City: � i_.5t Luc.1� Stater
Address: la'I�5 JJiLME.YLR eIKOX0—
Zip Code: %t1JC2- Fax:_
City:?Cart 5-r LoC16 State: F^ _
Phone Nct%-2.- 419 • 14g16
Zip Code: rJ t14Ja- Fax: �7y 33S I 949.
E-Mail:
Phone No. __.._.333 S' '..o 6 1
Fill in fee simple Title Holder on next page (if different
E-Mail: C,L-2,,1SN /s'78 & A61- - Ca Yn
from the Owner listed above)
State or County License! C'AC,o 5 S 666
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
8Zti-d ti000/Z000d 89 L-1P\ws -
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ENGINEER: Not
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Na me: _
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip: Phone:
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
commencine work or recording vour Notice of Commencement.
1
Si of Owner Agent/ Lessee ;Pffri of Contractor/License Holder
STATE OF FLORIDA ICOUINTYOF
STATE OF FLORIDA
COUNTYOF
The forgoing instrument was acknowledged before me I The forgoing instrument was acknowledged before me
this M day of §1U!aissT , 20 14 by this ALday of 8",p6 20__Ig by
(Name of person acknowledging) (Name of person acknowledging)
_w2ami, OUAL L,
(Signature of Notary Public- State of Florida) (Signature of Notary Public- S ate of Florida )
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
$=A WALSH
,*"�"`�• Commission No. # i ~i
Commission No.'ts.�SANP 1IMUALSH
+� r MY SIQN �FF99111$
?rf. MY COMMISSION #FF09fi16 RXINIRES April 11. 2014
Revised 07
REVIEWS
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ZONING
SUPERVISOR'
PLANS
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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 TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 inconflict 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 1 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. _
r
Si of 0 ner/ Agent/ Lessee
S' uriiof Contractor/License Holder
STATE OF FLORIDA
COUNTYOF S-r Lu-mic Co' u.0$+
STATE OF FLORIDA
GOUNTYOF 5�" bje-t�
The forgoing instrument was acknowledged before me
this Z8 day of "iIAT 20 14 by
The forgoing instrument was acknowledged before me
this 233 day o69r 20--14 by
(Name of person acknowledging)
(Name of person acknowledging)
JAL
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known %./ OR Produced Identification
personally Known � Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. VNDARIWALSH
Commission No.�A WALSH
SION #�FF081118
tMY COMMISSIONFFo8i118
J
.
=`s EXrIRES A041 11, 2018
^
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<f 3N It53 FNriMaN�t� iC6 GNrt
Revised 07/15
' FforldpNptarySenicecom
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
Kt-� Z000/ZOOOd 69 L-1 -WOai 8Z:0 L tiles 8Z-80