HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
PRQPOSED INPROVEIVIENT�L'OCATIO'N��' ' �E -.,
, ..., :. M -.xN..:.1 h-F i�Y.+L� u,... >_"4 --.: k I":F_.•: k4.1_FY.:-_"R�..MP.:o- ,P l�S�..FH:N :. .
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9�dfl4 ia'l Lake D.-
Legal Description: 2e-9erUe
ProPertYzTcax 14;#' Via/ . -dpp-c�a0.9 Lot No. J? _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sider Left Side:
D TAILED DES: RI T ON O U1/ORK �E.N
4 .7i7--V- 9" rel tQ e ��cL�G R
-j;0.0.
CONSTRUC�TIO:NINFjORMATIONra
Additional work to be pertormed under this permit-check-all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric v""Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
CCosRoCo str ction:$ 15Q®. °o Utilities: —Sewer —Septic Building Height:
W. ,
al
OW'N�ER%LESSEES ' � `���N't�-i �CONTRACTO�R:
�'m'�7
—Y
1Varne'c` M_440. �/d!'/'dZ0 (,IA
ame. �✓n �' 17rQ
Address: /rrraAe�d./.)� crJ ompany:
f City: lA-a'VP1ezq' '2t, State:Je ddressn: lm5/ AW F�e� �S� D,� t(,61 Aon,
Zip Code: 1040 Fax: ity. 96d �a zi.'6e Stater
Phone No. 2-7-me _ 30-_31x 7 ip Code: -3498(o Fax:
E-Mail: ihone No 77?,- 353- CoSlo 4
ill in fee simple Title Holder on next page (if different I;-Mail .jd-ACs q3 pe pv eS54)-A bnt), A<�
fr_om,.the Owner listed above) State�:or.County License
Et
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
"IJPPLEYMENTAL CONSTRU 1"1®N LIEF hAUV LNF`tRl\/I�TI'ON:
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 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
commencing work or recording our Notice of Commencement.
gnature of Ov ner/Lessee/Contractor asrAgent for Q-\i, r v Sigriatur "',GGontractor/Licens6 Halder
STATE OF FLORIDA STATE OF FLCI1DA
COUNTY OF COUNTY C WW—
The forgoing instrument was acknowledged before me The f going instr ent was acknowledged before me
this day of 20_ by this�day of�p 12017 by
t`f6�a c,.
(Name of person acknowledging) (Name of person acknowledging)
hbx M YJtI1
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known N,.-QR.-P,[oduced,ld�,e t ficatio
Type of Identification Type of Ide9pTication LI A M.CAUDULLO T^�
Produced Produced �(ja 1. � c-
State of Florida ;�
Gommis'ton
F 242841
Commission No. (Seal) Commission No. �'T } ''Sr i P riy CI'�a0)(Pires Sep 25,20]9;
^+ Bonded through National Notary Assn.,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.