HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'2o-17 Permit Number:
- _ 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:
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PROP SEDI'NPRO /EME 1.®CATIQN
Address: 1206 Al-e 79leS vW erGFL 3 yq5_7
Legal Description: lV7�leS _TS�an jnC• 3Zyy',25
Property Tax ID#: ��Q� -50) - J 3 9 3 -000 - Lot No. 120
Site Plan Name: /J/e#hps Block No.
Project Name:
Setbacks Front, Back: Right Side: Left Side:
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CONSTRUCam
TION INfORI\JlAI'I®N; #_£
ep# .w£a# .. '�rotakx` � at 3AT^ t'��°.Fk x -ay_,. -#�ffF._ rNY.,' 4 r per, _. ,.�., :• .s F-aWi
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping' _Shutters Windows/Doors
Electric _Plumb`ing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: CP0 Sq. Ft. of First Floor: 6�C✓
Cost of Construction:$ 1700.00 Utilities: ASewer —Septic Building Height: 81*-
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01NN,ER%LESSEE C®NTRI�CTOR; � �
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Name Can-/ • _1,40 Name: uo? T7�li
Address: .1�. 0. Box /3'9kl Company: rn Dje�vf C _Z?c
City: W25/ 9aIm Bee.CA State:F1_. Address: id/ 4/,::�r 52'
Zip Code: 33yl6 Fax: City: zrBr1S@r? 9,eQ, State: /CL-
Phone No. d/7 3q7 05-33 Zip Code: 3y957. ' Fax:772132 .211q/
E-Mail: Phone No 77.2- 260' 371,E
Fill in fee simple Title Holder on next page (if different E-Mail 4 warn S 071 7114 ;n C yahoo •eorh
from the Owner listed above) State or County License f/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1�PPLE'MENACONMRUCTI®N LIER! LAW I`NFORMAl'I®
DESIGNER/E EER: _ Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _Not Applic BONDING COMPANY: _Not Applicable
Name: ame:
Address: A ess:
City: City:
Zip: P e: Zip: Phone:
OWNER/CO RACTOR AFFIDVIT: Application is hereby made to obtain a permit to do th ork and installation as indicated.
I certify that o 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 t subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may rest ict 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 cordin otice of Commencement.
1
Sign re Owner/Lessee/Agent Signatu o Contractor/License Holder
STATE OF FLORIDA �p STATE OF FLORIDA �I
COUNTY OF �1 �L /C�l COUNTY OF f !Ai ,�A p
The forgoing instru =enkled ed before me The fo g9�ng instr a was acknowledged before me
this day of20 by this� ay of 20)� by
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(Name of person acknowledging) (Name of person acknowledging)
(Sig of Notary Public-State of Flori a (Signature f Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificat'on (� 1
Produced ( �� �q� ��,, TINA F: IAB QBtd�uced k I� l_ r� TIMA MARIA13RIGG
2s.�
<.s �:rO � NO a'ARRY PUBLIC
�. s� �1:-� NOTARY PUB iC F
9 STATE OF FL R4i� emission No. y%TE OF FLORIDA
Commission No. c ? }) ;� q
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u � Carnm#FF1 1415.3 s%ac his Expires`502018
-u a it Exoires 5/212018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014