HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^4 �1 4
Date: Permit Number: 1-7 0 ^003
Building Permit Application
Planning and Development Services
Building and Code Regulation Divisiony
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: SII C �Qyi I�'e
.2A jA f/e
Legal Description: Z,sj er 2QU_ �=- --u ikr A T31 Cc— 79' L-o-�
Ll
Property Tax ID#: 3 LIf F - 5-6 0—G 09 1 — 000 ::T Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
9
Aon tvk- ukl( F-0C)
CONSTRUCTION INFORMATION:
Additional work toe performed under this permit—c ec a11 appy:
❑HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric LTJ Plumbing Sprinklers ElGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construct on:$ 980 UtilitiesInSewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR'.
Name iKL. O-k Name: I rl'IS
Address: `` ftF T—uv,, c SO 1J('_ Company: _eCJ.n.tro
city: State:12— Address:
Zip Code: 3 `1 L83 Fax: City: `G d State: FL
Phone No. 77;1— Zip Code: .?tl 9 c;�, Fax:
E-Mail: Phone No. 7v2 0 il
Fill in fee simple Title Holder on next page(if different E-Mail: jvSc
from the Owner listed above) State or County License: �' r
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION ;I
,RrF
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 fir i spection. If you intend to obtain financing, consult with lender or an attorney before
commenci wok or record' our Notice of Commencement.
Signa re of Ow r/Lessee/Contractor as Agent for Owner Sign re of Con actor/License Holder
STATE OF FLORIDA // / STATE OF F RIDA
COUNTY OF 7 7�• G (J L COUNTY O '2_1 L U C r
The forgoing instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this�day of v 7 20�by this � U day of ��i L> ,20 /) by
Name cipers•n making statement Name.of perso making statement
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of'Notary Public-State of Florida)
+ EMANUEL GA(lS O Commission No.
Commiss' rj�] �';: 4` A U110802E
MY COMMISSION#GG116741 ° MY C OMMIGBION 0 GG716741
EXPIRES June 20,2021 itbt!!i.RE3,Nne 20�2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17