HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: a� 1 0 Permit Number:
SES 201Z17
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: To Select from dropbox, click arrow at the end of IineSA^ - -�
PRCIPOSEU]MPR0IIEMENT LOCATIOiN .&
Address: /0 -
V K,Jc+ayl b F+- -PielCe- + PL 34ciS I
Legal Description: 5,PAt-�14 LJ-V-'F_S C U-0-1 r1.l C.LIAA3 Vte.LA,(.E
Property Tax ID#. 3 C��-�1 Y did�'oa�`S Lot No..
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONO`F bRK ` g 4
4
"CONST�UCTIOIVINFORMATION n
Additional work to be pertormed under this permit-check allap
❑HVAC Gas Tank Gas Piping 'tn_Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers E]Generator E] Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
f
Cost of Construction: $ SSD Utilities: —Sewer Septic Building Height:
01lIFR/LESSEE yaw;„w ` CONTRAfCTOR .
Name K Lrci- 7_0-1190/° Name: l T?Ivt tn�,CJi'�
Address: /C) Company: /-+f'l'llgA 1NlyiAovyS --liP 17yoY5
City: r-f- p/e-I'ca- State: K- Address: 4300 _5N G{ I DO
Zip Code: 34951 Fax: City: IiiUei State:
Phone No. "I7P - 24a - SSI 9 Zip Code: Fax: q5q (P Sr, - S1q l
E-Mail: Phone No. QSu{-del-15 Y5
Fill in fee simple Title Holder on next page (if different E-Mail: Car ri6 o fa--pp 0 q pKrl+. co AA
from the Owner listed above) State or County License: C9C. 132_(e,q 85
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU ?�PLEMENTkLCONSTRk1CT "
10N LN LAW INiFORNI.ATI(3N G h, ;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: one Zip:
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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/L ssee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORQA STATE OF FLORID
COUNTY OF �f2oL4 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�gS'V- day of$ro Em&E 201 ? by this L—day of 5SPTfkm4tX_ 20 t"l by
-TiMOT1{-+q aosoJsoJ
Name of person making statement ✓ Name of persoymaking statement
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identifica ion Type of Identification
Produced L Produced
`. ) — /11�_ .Z_____D_
TAPP
(Signatu a PU P&iiary9Wo C)AkWrida (Sign d�* *�_rydlatiplfurbS a £d 4fAh)
;.; ;•ie -Commission#GG 056993 N+ ,•; Commission #GG 056993
Commis o:S M Comm:Expires Apr CQegQR1 Com iso} �O.' MY Comm.Expires Apr 15,20r I)
�iiF OF Fll,i i i iN``,
Bonded through National Notary Assn. Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17