HomeMy WebLinkAboutBuilding Permit Application All APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -7-31 - 17 Permit Number:
Am >f RFCEI' =D JU1 312017
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: Pernob"74io-A
MINN.'®SE/0315)
D IN �R�O�uEM ANT LQCATION: �
Address: / 0 31 5) S Oee4r Oi. -012-3 .Jen.fen , e-i c�i, !-6. 761%5-7
Legal Description: (/ ;n le,,11 V`-,oYagf _5-ea /7J,1/9/j'aYg8-302
PropertyTax ID#: '7 - 1$�D' Q��O `D04 Lot No. 1.23
Site Plan Name: WI'4 Block No.
Project Name: 1,23
Setbacks Front "Back: Right Side: Left Side:
. v
D TAT E D D C�gC� iP ICON J®
!11100M
C«O STR+UCTION I�NF®R+- AT ON:
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: d 3y Sq. Ft.of First Floor:
Cost of Construction: $ /70000 Utilities: eysewer _Septic Building Height:
OWNER4111RS- EE: ON`fRAC 0'R:
Name .,Name: f
Address: �O���Q -S- QC�n ��:= #00/ Company:
City: S� _011 hoc. _ State:OL. Address: .,Zll :/!%cA•
Zip Code: 3 it Fax: City: 941Acl, State:/ICIZ.
Phone No. 772- 221-35'77 Zip Code: 3y95'7 Fax: 772-.239-.2191
E-Mail: Phone No 77,2- 2B -37/3'
Fill in fee simple Title Holder on next page(if different E-Mail c el-407 fM j-1-4 ;AC 6)y0-400. 5'0"
from the Owner listed above) State or County License CRC 42 /57Y1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
UPF'LEMENT L CONSI'RU TI®N LIL�N LAW INFORMAI"I®N:
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.Assoclation'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 rpeordingotice of Commencement.
0
Signature f Owner/Less eelrontractor as Agent for Owner Signature of-Corifractor/License,H615er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5'-�.'-L13cA'C COUNTY OF '!S>r- LSc r,e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _day of -3 u\y , 20 0 by this�day of 20_4 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature-of Notary Pu lic-State of Florida) (Signature of Notary Pu ic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifi
Produced — L fl
NA ARIE GENS Produced
r�;—�EANMI:_; IE GIVE
...? :c;.
MY COMMISSION#GG 022023 .�, =
Commission No. ' r, "__ Commission ti $ Y rnissloN,#G
{��)December 16,2020 :De
r' moo? BondedThruNotaryPubllcunderwriters ?.• Bonded December y
o F`• Thru Notary public Undenuriters"
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA.TURTLE' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEWREVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014