HomeMy WebLinkAboutBuilding Permit Applicationi
All APPLICABLE IN O UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II
Date: i
Permit Number:
: F,
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 —,Z—
PERMIT APPLICATION FOR:
PR r} P05ED 1NPRC�1/EME� T LQCA�TIQN•
Address: i a. A a Po
Dr
Legal Description: ko S/n S 1 s rT o
c,, f 3 c� A at l i Co f y (09 Cl z ( �
Property Tax ID #: 2 cd 3 6 o o G
�-fid _. 1 Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
E R IL D DESCRIPTIO
vPIcaAe- Sefv-Ce 4--D If-GO Ang
G.nd CC, IleC) Ad,
CO` . 5TR'l1 TIO` NFO
Adc-litional work to be peffo—rmi-e-d uncler this permit -check
all that app y:
chanical Gas Tank Gas Piping
Shutters _ Windows/Doors
—Me_ _
_
_ Plumbing _ Sprinklers
_ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
_
Cost of Construction: $ ll Utilities: —Sewer ._ Septic Building- Height:
N ' N'E /LE5�SE{E
CONTR,4 0'R.
Name TokA A Ve/tzp L
Name: T(ay' �G✓e�9e
Address: 'Ener;a,i GRa(.'s D
Company: 'v veno SSS.
City: tf t- craz State: %
Address: cd'
Zip Code: 3c-19q2 Fax:
• City: State: ai
O
Phone No. 1_ �?� /
Zip Code: 3 Kg53 Fax:
E-Mail:
Phone No 2- 'La(-7T55
Fill in fee simple Title Holder on next page ( if different
E-Mail L/en9 o . 1v-'k11. -con,,
from the Owner listed above)
State or County License r C 13 GLiK
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU��P EMENTAL Cd ` STRaUJ�T101� LIQ LAVV LNFORMATION`:
im
Signature of Contract nse Holder
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: - Not,Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE BOLDER: _ 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 recordine vour Notice of Commencement.
Rev. 7/2U14
Signature of Contract nse Holder
Signature Owner/ Lessee/Contractor as Agent for Owner
of
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF C 4- Ly c %'.e–
COUNTY OF e4- 47JGi
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of G 2017 by
this day of mQ �� 20 f� by
—1–o orb VG. -t
(Name of person acknowledge )
(Name of per on acknowledging)
0, 0 � C' q , L A,,,
0121iS,- �- 21�1+
(Signature of Waroy Public- State of Florida)
(Signature of o ry.Public- State of Florida )
Personally Knowngduced I6�fttYfit@T&�
Personally Known r ` ucettai'
CATHY
Type of Identif ation r° B`�; Notary Public - State of Florida j
YP� , , , ,
221706
J ROGER TS
Type of Identificatio `� Pio;.,
og Notary Public - State of Florida
Produced •; Commission FF
+
Produced-Issiont FF 221708
�•,, �.°,• yComm.Expires May 10, 2019
'•,,�o F o . ?
(). «, P. �� National Notz Assn. '
No.
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`' d m Ex ' es May 10, 201
Commission No. /��}� ,,, .��°° p ` y
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Commission I a►?_ � y:_�ry� ._ ,
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2U14