HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` I jp Permit Number: -065 ^U �J
I l
l �' --,
I F Building Permit Application MAY 12 2w
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie Cou .ty, FL
2300 Virginia�4venue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
I
.,u... - i s-e .ar t t' d 7u,r 4 $' -� a 1 Z`
Pcl�osEo Ipl�ouMt LocAT)cN � �� a �h
�'
Address: G Pf
I
Legal Description:
Property Tax li#:_ �,c �? 16 �- C) �3- k 00 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Friont Back: Right Side: Left Side:
0,9�6;ANhMV. f WN
1 -r`
QET IL DQE C "10T,IQN OF W.QRK r�nb �h x
_ �a i ' +�`�.,�t£ a E d': s`" E ft .��, �'�.s �i `+ rn" .«y � �• �`t ar¢
µs_4 ,ir,4
Mla -J ".r X d + 1g� � 4E dT � ' .J "rtj ow �1
Re
f,
1_
itiona w Ir to a per orme under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping `' Shutters _Windows/Doors
Electric Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of ConstrIuction:$_ (� �� Utilities: _Sewer ✓Septic Building Height:
1 s �ti�Z, Mu�I=_ I .N.. 3t"fA(.s, y .*a?c c-;,c, e�.'= '�".
I��r„lti,u ?i�s'� h�i'k ' .,. FIf7;"gs�t.v2..z''.a:.Av �L .u�,` - ,•_' ,x;Sk L':_� a,r ,x,'ao- 'iw,ax '#t"ir'e1,h��,
I
Name S6 LA-C
Addresses Company: r4 l 0-
City: sri& State L Address: `X
Zip Code: �'���% Fax: City:� State:' L-
f
Phone No.�,) i— 134� 'l Zip Code: 34(q-5`) Fax:
E-Mail: Phone No-17' <"C1 C)
Fill in fee simple Title Holder on next page( if different E-Mai00-tt n o H kq6 -C)\1 Vn\&<z CC 91.0
from the Owner listed above) State or County Lice nseC- -C-: d 7�r
If value of consitruction is 2500 or more,a RECORDED Notice of Commencement is required.
I
S�UPPLENIE ffl C®NSTR=CNT ' IEN LAU1/ I°NF®R,MATIO;N:
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 thepermit 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
m nc' wopk"51i rpcording your Notice of Commence ent.
(14k
S' nature of 0 essee/Contractor as Agent foy'_ Si :ure of Contractor/Licens older
TATE OF FLORIDA . „ STATE OF FLO
COUNTY OF COUNTY OF
XC D n XK a
The orgoing instrument was acknowledged before m� The forgoing instrument was acknowledged befor @I
this day of 20A by cq9 this day of 20� by 9 rn cgrN-T
Lp
iv
er m
(Name of person a knowledging) a " (Name of person ack owledging) "IJ
LLIII
(Signature o otary Public-State of lorida (Signature o N ry Public-State of Flori a)
Personal n;o OR Produced Identification Persona nown OR Produced Identification /
Type of I enti ' tion / // Type o Iden 'fi ation /
Produced ( .xL(1 Produced _
Commission o. (Seal) Commissi No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4