HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ANI.:- _
- 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 line
PROPOSED IMPROVEMENT LOCATION:
Address: &1ci5 _Scxnr1pine c - - oiA st L vc / 3CiG �a
Legal Description: L_.t,k-C. Luc ::re Rice. f 1Vo- Cine_ t of 46 (i- i i7a-D3 jS-95-
i i�:0," : 3 CI 5 -a a Ci S'�
Property Tax ID #: 3 Lim G -7o _ t;()"jy _ C)00 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
VA C✓ Lx KL t'ocz L, 1� n SeC-R 6.E N riox 70 A)
EL_!!o oqt Z,30 - f &V a7 U H b Y P L 30 q kW
CONSTRUCTION INFORMATION:
��ition'a work to e oerformed under this permit - check all appy:
LdHVAC Gas Tank F]Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
L-1 p 5 0
60
SFt. of First Floor: _
Utilities:12Sewer Septic
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name S�AT t2\ c \A VeA 7-c- N
Name: :e,Ef L - eiof4
Address: S%qS SAA, IZ_cC.
Company: CC54- 616- -Fe c, fl N6Lo!5zE
City: Partfi' 6+ Lyc IC State: r�_
Zip Code: Fax:
Phone No.
Address: QS78 "16rms-1 ea- CItzcC(—
City: PO/LT 5+ Loc r8 State:__F_2__
Zip Code: 3L/9SL Fax:
Phone No. 1-)2 -zo 6 /
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: C!-P/a J 5'��1 (9 i9a t • (50M
State or County License: CA C C) S-8 6 6o
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City: State
Zip: Phone
ble MORTGAGE COMPANY: _ Not Applicable
Name:
_ Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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
rnmmanrino wnrk nr rernrdin2 vnur Notice of Commencement.
Rev. 8/2/17
Sig u ntractor/License older
Si o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLCOUNTYOFORIDA �T LUCIL Cvvn� ��
S� �.vc!
OUNTYOFSTATE OF ORIDA E C�J�7�
The forgoing instrument was acknowledged before me
The forgoing inr ment was acknowledged before me
this day of �f� »'lb0'C 20 by
this day of S EpIEM,J 6 iR 20l% by
41t177
Z�- 6 E /-�L>,e;J-A
e
Name of persogrdaking statement
Name of perso aking statement
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
A a
Joy'ZL '/
(Signature of Nota i� tate GfA4&R14 WALSH
(Signature of Notary P blit of FI
%MDRA WALSH
MY COM SI N #FF091118
Commission No. ^,=ea�
EXPIRE April 11, 2018
"=` MY C ION #FF091118
Commission No. �` oQs
EXPI ES
oci��,.° April 11, 2018
(407) 398-0153 FloridallotaryService.cam
(407) 398.0153 FloridallotaryService.com
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17