HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (9�
Date: Permit Number: o
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:
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Address: '� 7 tC U'i� cl �' L # .� tiT(;'• s "li
Legal Description: ,;
�. � '� j ✓fid' � `;" 4I y11✓ S �C� c� l�eUI .i5"
Property Tax ID#:F6J,,b:•, f 0. [} ` �C ' Lot No.
Site Plan Name: Block No. S
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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:/10 �i11� 17,
30
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CONSTRUCTION INFORMATION-::. ::.:.: :: . :;
Additional wor to be neffo—rmedunder this permit–check all Vh1t appy:
E1HVAC L_I Gas Tank ❑Gas Piping _Shutters a Windows/Doors .
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
`c'_ w pro
Cost of Construction:$ z J_5 Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: .CONTRACTOR.::
Name n �If�kALAI Name: 11�
Address: Company:
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City: Cit f y5 i _. State:`s'Z Addre ss S 0 y-. 'j-, ��t�t'€r�?2�:rvl
Zip Code: "n-`in 3�.^ji Fax: City: x :. v\ State: `
Phone No.
Zip Code: s" Fax:
E-Mail:) tl =���71r,�t-G+r :. t b
�•'� t'��'. ".:�� Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail1.
from the Owner listed above) State' r County License: ;'+
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
E00/T0012) XHA ZS',ET LTOZ/ZZ/60
:Sup ENTAL CQN5TRU,QTION1IEN.LAW:.INFORMATION:
DESIGN Eft/ENGINEER: Not Applicable MORTCGE 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: rr' City:
Zip: Phone: Zip!" Phone:
D*NER/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
commenci-ng work oxjr:ecording your Notice of Commencement:'
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Signatur.�::of Owner%Lessee/Contractor as Agent for Owner fSignatuof"Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF "�t- f_,•.•f 4 COUNTY OF
The forgoing instrument was acknowledged before me The forging instrument was acknowledged before me
this% �� day of '` 20 I: by this ix.-'day of 5-t.c 20 1''7"by
61
Name of person making statement Name of person making statement
Personally Known i_... OR Produced Identification Personally Known M-- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
rc`'p•e�.?�.. LESLI D ZEL.AYA
(Sigriature of NU iy bl i�1reQ l�iW1qi FF165172 "(Signature of N tary b ic- Int@ it (3rMi ;xFF165172
Q' EXPIRES October 1,2018 '+"�' `�'�' J�
(- f, :' EXPIRES Octp�$ber 1,2018
Commission No 14071398-0153 Floridallota��ce.com Commission No. csidallotarySee�c�.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
£0o/zoo 12 YVA Z4:ET LT09/9Z/60