HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:1 1 - 3 • ILD Permit Number: [�
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uilding Permit Application NOVN0 3 20$6
Planning and Development Services PEhliliT T ING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial K Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED KAPROVE MENT LOCATION
3.. R
Address: I Q (o So 5' 0 L� _T>246(6'
Legal Description: 15L-4nj0 WdE!;J-- 6o"6b OMI- S-09 Awl) LIN 01Y Sl{nq-rt��
Inl c,ow•M aN 1ZR L-/KErVT"S �pa 318 K 3Lf
Property Tax ID#: y 511 -SI (o -00T&- 000 Z Lot No.
11
Site Plan Name: ` �u_, L_ V Block No.
Project Name: TOTL.15�
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Setbacks Front N low Back: P Or Right Side: N A Left Side:
-"DETAILED'.DESCRIPTION OF WORK x
�E7\7k- — SL(rDlAi(o (30 SS P6J rL J&I
CiNSTRUCTION INFORMATION
Additional work to be nertormed under t ispermit-check all appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric Plumbing Sprinklers [Generator _Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ L-.0 C-3 Utilities: _Sewer 0 Septic Building Height:
O11lNER/LESSEE CONTRACTOR
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Name Name: (G
Address: 13D S C�G'7 .1 SOcI Company: IZW A/A/ So '`J
City: �t�} State:_�_ Address: J9JSVj �f�ff-�- A1fAMLAJL!/4 - I
Zip Code: ?4,19 f�7- Fax: City: S-Uacw4— State:-f"LL
Phone No. 17L- 7ot3 -144$ Zip Code: Stigq!� Fax: 6-M -4-t'-4L4
E-Mail: 16JTL�o T12"g el3at-'S'bort},NET Phone No.- ?ZZ - (oq2 -Z)j4 c�
Fill in fee simple Title Holder on next page(if different E-Mail: l LL�+/kErLL.C-,Oo'��►/l1•.�•�a-lfoc�,c.bi•,
from the Owner listed above) State or County License: s-
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: ioMlnlam 046 LLG Name:
Address:j31A& 53BT,4 5ffiqdE5Ea: Nat 101 Address:
City: State:J2t_._ City: State:
Zip: 2;.: Phone: 3 - caa7 Zip: Phone:
—a
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 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 fa•lu Record a Notice of Commencement may result in your ing twice for
improvements to your prope otice of Commencement must be r orde an don the jobsite
before t first inspec ' n. ntend to obtain financing, co w' len r orney before
comm ci rk or eco our Notice of Commence
s
Signatur of Owner/Lessee/CcKtractor s Agent for Owner Signature qf Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF >-�;T /L1 SCJ, COUNTY OF !!�j— ,Llxl�
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this�rday of 20/�by this day of 1/��// 20 C�by
(Name of person acknowledging) (Name of person acknowledging)
(Sign atu`re�o Notary Pub i/c-State o lorida) (Signature—of-Notary Public/-State of Florida)
Personally Known V_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification roduced
Commission No. Commission No. Seal
ti:PY^ice; ANN M.GAUMOND
;.: MY COMMISSION#FF 173907 =qti• ANN M.GAUMOND
:a= December
Revised 07/15/20 0 V,'ae,14 ` Bonded Thru Notary Public Underwriters EXPIRES;December 7,2018
%17Bonded Thru Notary Puhl c Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS