HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c J A t /��01 Permit Number: *7
P
.a
1111
Building Permit Application MAY 12 2011
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 v Residential
PERMIT APPLICATION FOR:
PROPOSED INPROUEMEN .LOCATION z =_ T I
r F
Address: 7 fri C �. c 1 144y bA7 ,s.v L,_,4 rP/
Legal Description: L CG .�3 c � ::2 �7_ , c j "
Property Tax ID#: 3 7 Z 2, X41 ei /d Cg C& (a Lot No.
Site Plan Name: �_��5� c- j, /1 Block No.
Project Name: C A��',{���-7�NI-7
Setbacks Front' Back: Right Side: Left Side: 1' )f'u10
D DESCRIPTION K OF WORk
2 1
DETAILE
...:�,k` .._.. -
ID e-PI us4 < a�L) b t� Y1 U-91 IN EU �'
6L,I1 GAPPfiAQ f�7,� �< i
v _ i r ' i air "I r l I ,P,�p r u 1�5.,: f: Yr#moi
CONSTRUCTIQN
IN: r
.. _ ........ .. ' r. _ - ' r. YF iii_. Myr. i 7
Additional work to be pertormed under this permit-check a tat appy:
_Mechanical _Gas Tank _`.Gas Piping _Shutters _Windows/Doors
✓Electric ✓Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction:- Sq. Ft:.of First Floor:
Cost-of Construction: $ y 6c. Utilities: _SevJe`r ls� Septic Building Height:
a , x rt �, y ?� g
i r 1 vn r .F , n3�aa��5'i rfpyF.y .1�,1 i
OWNER/LESSEE _ 1 CONTRACI'OR.r qr Ip aL Awy ai, '' r� 7 ;� . _� y
n
Name ���L_y� 1 ;_A= r Name: D .A d J,759_ `{-L✓(/�'OZ
Address:_[) Z. Ptdy��� e 7 Company: S <5Ea) fZ.4-V
City: L— ami Stater Address: Zfi 2 ? S E- e:2'_t-A/ 4✓_
Zip Code: 11603 Fax: City: P.SL. Stater
Phone No. Zip Code:3yg,-rFax:y7 7-
E-Mail: Phone No y 3 3-<--Gd r--
Fill in fee simple Title Holder on next page ( if different E-Mail �0 S_qjLg4L :t - C4
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
lP11/1NTi�►L C(7NSTR�JCTION LIEN LAW INFORMATIbN
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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
improvementst-no r property. A Notice of Commencement must be recorded and posted on the jobsite
before the fir t insp ction. If you i to obtain financing, consult with lender or an attorney before
commencingwork r.recordin ur No ice of Commencement
Signature of ner/06s;eeCpRfiractor as nt for w Signature o ontractor ense Ider
STATE OF FLORIDA STATE OF FLORIDA r
COUNTY OF COUNTY OF '
The forgoing instrument was acknowledged before a The forgoing instrument was acknowledged befor �6
5L
day of 07 2017 by cN
this - this day of n'7 2017,by z o�5 I
d
Z
www
C3
FL 2
q UX rF ,
�ael �� � �1er zwm �� I h� v -
X v
(Name of person acknowledging) (Name of person acknowledginga4A- )
Yo 4
� � •'O,y�*•9;'.(,: Vim/ .•o •L• 0.
(Signature of Notary blic-State of F orida ) (Signature of ary Public-State of Florid )
Personally Known OR Produced Identification Personally Known OR Produced Identificatiori----
Type of Ide ' 'c tin Type of Identi is •o
Produced / C✓ Produced �.
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.