HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Y
Planning and Development Services
Building and Cede Regulation Division
0
P
ermit Number:
Building hermit Application
z.suv virginlO Avenue,, Fort Pierce FL 3498,e"?
Phone-, (772) 462-1553 Fax: (772) 462-1578
Commercial
Residential X
M •
Legal Description; Kiver Haw -unit 4 B1Vk 40 lot 6
Property Tax ID #;
3419-530-0228.000-7 Lot No.6
Site Plan Name: Block No.
Project Name: Dols residence
Setbacks Front Back: Right Side: Left Side:
-�L
H VA C U Gas Tank
aElectric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ �(1
Gas Piping LJ Shutters
Sprinklers
Generator
Sq. Ft. of First
Utilities:
Sewer
Floor:
J Septic
Windows/Doors
I J Roof
MEEEEO-�
Building Height: _
Roof pitch
City: '"oR at iucie State: FL
Zip Code: 34983 F'axlv
Phone No. 772-359-1350
E -Mail:
Fill in fee simple Title Holder on nextpage if different
from the Owner listed above)
Address: PO Box 7305
City: Port St Lucie State: FI
Zip Code: 34985 Fax: 7723372699
Phone No. 7723370055
E -Mail; nrblosser@gmail.com
State or County License: EC13001570
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
1 f E Coproma Ave Port t li ne R Addre
a
citya Ponstiucle -ate:
St
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name.
Address: Po Bax 7305
City:
Zip: Phone:
Name P Kent E3losser
AddreSS: 183 NE Caprana Ave
j
C"tY@ Port St Lucie
State
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip Phone.---
OWNER/
CONTRACTOR AFFIDVITO. Application is hereby made to obtain a permit to do the work and installaticmas indicate.
certify that no work or installation has commenced prier 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 canflFct with any applicable Homic) owners Associ I at
structure. Please consult with your Home 0)%Nners Association a�drules, �,�ylaws or and covenants that may restrict or Prohibit such
your died for any restrictions which may apply.
In consideration of the granting- of this requE2sted hermit, t do hereby agree ree 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: r��m additions
r
accessory structures, swimming pools, fenCEIS, 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 job
site
before the first ins ion. If you intend to obtain financing, consuli lender or an attorney beforecommencing w or r cordin-pir
gyou� r Notice of Cornmencement.
ignature of Owner/ Lessee/Contractor asAgent for Owner
STATE OF FLORIDA
COUNTY OF 5
ro,
The forgoing instrumentwas acknowledged before me
00-11
thisL9tl�dayof �• ,20�by
Name of person ak
ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
(SAtu4 re of Notary Public- State of Florida )
Commission No. �Cs' �ip ��f()R BOUCHIO.R
"• :'? MY COMMISSION # GG09181
EXPIRES April 09. 2(121
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
FRONT
COUNTER
ZONING
REVIEW
SUPERVISIDR
REVIEW
, 611P1111111111111111111111111
Signature of Contractor/License Holder
STATE OF Fl
COUNTY OF
The fo oing instrou ent as acknowledged before me
this i�i day of , 20� by
Name of perso- making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signliuroe of Notary Publi pt Flori Y R i3OU�CHER
:ommission No. �f�w'� ��e MY C�t��SlON�tGG09181
PLANS
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.'+;e;#041, , •' EXPIRES APIR 09t 2021
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