HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ''S�' 1,3. 21. Permit Number.
RECEIVED
Building Permit Application
Planning and Development Services APR 13. 20'7
Building and Code Regulation Division
'23W Virginia Avenue,Fort'Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 'Dr ) v e t&,7
AtA
Address: '3 Gel 4-c6� PSL L q ?Sr
Legal Description: R I 02�t Po-,t4 V K) k 45- D•T '2-7
Property Tax ID#• 0 0 0 5 Lot No. !Z-'
Site Pian Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
Appo)c G ,2-S7 S Go c_,r e_ -e C/ <<
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Additional work to be performed under this permit--check all that appy:
Mechanical _Gas Tank ,^Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction: ' Sq. R.of First Floor:
Cost of construction:$ Q,, 6 00 , 0-o Utilities: —Sewer —Septic Building Height:
Name Name:
Address: K Company: _,_, c�nlc�-i'l��(V 1 f2 1. .
City: State: L Address:P,O . I30>< Ij
Zip Code: %Z`4 9'(o Fax: City:f 2a 1't'';• &L rJ mc) Stater
Phone No. 72 Y3 'x( —2 96'Z- Zip Code:- Fax(7777)Zrd.3 --H 55
E-Mail: L i t 0 Z 7 O a-i .ADL• Phone N z 0 3 6
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C8 G 0027-164
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
DESIGNER ENGINEER: Not Applicable Not Applicable
_ pp MORTGAGE COMPANY: _
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 au applicable Home Owners Association rules,bylaws or anti 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 alfrespects,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 ac'ce'ssory 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
comnpricing work or re9ording your Notice of Commencement.
i i
Sign re of Owner/Lessee/Contractor as Agent f Signature of Contractor/(' ense Holder '
STATE OF FLORI , ' Aq STATE OF FLORIDA -
COUNTY OF °: '' 'COUNTY OF 4&7&
The for oing instr ent was acknowledg d befor Q The forgoing instrument was acknowledged before me
this i da of hG1� 20� b —�
y � y e m�m this day of � .20�, by
Z M 2
seP0
0
vtmd� A/W
Name of p s n acknowledging) o ame of person acknowledging)
v '
(Signature of Notaiy Public-State of Florida) (Si ure of Notary Public-State of Florida)
Personally Known OR Produced Identification `� Personally Known V" ,dX§A1A4W0dJNE-l?JL!►
Type of Iden t c 'on Type of Identification EN
MY COMMISSION to FF96
Produced . Produced xPIRESFelxuary 91.20 0
Commission No.fF9(PD 139&QrwriatNora efv Colr
Commission No. (Seal) '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/21114