HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;Ll Permit Number: lsl I I u
J J
Building Permit Application NOV 0 3 2910
Planning and Development Services
Building and Code Regulation Division St. Lucie FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial A Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR AT
,QPQSEQ.IM,PROVEM,ENT LOCATION:
Address: 1OuqLl -S QGng 122 110-7
Legal Description: ?ZkubAjos cmr400 A-PT iio-7 g_ 761 Z 37C
Property Tax ID#: So L4-oo3-7 -ogo -il Lot No.
Site Plan Name: 3u e ri c-r-r Block No.
Project Name: f,u rz'fvgm�
Setbacks Front NIA- Back: Right Side: Left Side:
D'ItT' A*-Eb DESCRIPTION WORK' ' ',`". '
D I
'WNSTRUCTION, INFORMATIOW
Additional work to be performed under this permit-check all that apply:
—HVAC —Gas Tank —Gas Piping —Shutters -xWindows/Doors
—Electric —Plumbing —Sprinklers —Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 41 Z t-o Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:. CONTRACTOR:'
Name !?X)YM t_� I AAAVL,(L_WA) Name:
Address: 1219 M W0656MI4, YZQ S7 Company: 96_7yr6-A1 Zg&.&LWXWII�Ju�1!I
City: State: Address: I74.> /v&t,/ iCi919t,47__ AT—
Zip Zip Code: 4Qt)6,r) Fax: City: vy4y� State: r--L-
L-A 2"K'7ii,,�
Phone No. Zip Code: 31-f liqtf Fax:_Olwrp�
E-Mail: r Phone No. (0 q 2-0 C-1'--"
Fill in fee simple Title Holder on next page if different E-Mail: A4tc,& / Goof)v4illj
from the Owner listed above) State or County License: C&C, 115_'o5(4377
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENI`AL CaN5TRl1CTIQN UEN LAUtiT 1NFC3RMA1'ION re ,m v` sF
'r
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: SUN(_QM>— 0&&K4JNI M W Name:
Address: PVwvtk (Address:
City: n ji912"H-TE'?L State:—f!f, 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:
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 resin ur paying twice for
improvements to your pr e . A otic e of Commencement must be record /annposted on the jobsite
before the first ins ecti . If o tend to obtain financing, cons it e attorney before
commen ' or r cor In ur Notice of Commencemen .
s
Signature of wner/Lessee/Co ractor Agent for Owner Sign—lrui6 of Contr for/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST �,_L�C�F COUNTY OF SST
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisl9Tayof ZO(/ 20/Zby this/s day of;/)94120 / by
(Name of person acknowledging) (Name of person acknowledging)
(Signat otary Public-State oTFIorida) (Signature bf-Notary Public-State ofF_Tori�da)
Personally Known ✓ OR Produced Identification Personally Known L-1"*"OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. arm Commission No.
� Y°i''•. ANN M.GAUMOND ANN M.GAUMOND
MY COMMISSION#FF 173907 _+: :+ MY COMMISSION#FF 173907
EXPIRES:December 7,2D18 ,o EXPIRES:December 7,2018
Revised 07/15/20 C 11
Al,fid Bonded Thru Notary Public Underwriters L' ofQ°`' Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I l