HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o Permit Number: 'I n_w •03Qa__
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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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P,ROPQSED 111JIPRO;VEMENT COCATI17N I'
Address: �
Legal Descri do :Qi �Ve_c- A(L 5 Q) (-Y—(... R-5 r3Lf
Property Tax ID#: Li I ci - 5Li 0- CSI(D `� - OL - Lot No. 0 S
Site Plan Name: Block No.
4-7
Project Name:
Setbacks Front Back: Right Side: Left Side:
TAILED DSCRIPTION`OF WORK p ,r ' ROMk ,} {
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epjc,ce �x s-h n5 ,?e 5 ) , I W
a -�r, , 14 Seer, -J.S 1_w
C�NSTRUCTI`ON INFORMATION a
... . . . .
Additional work to be perrormea under t is permit-check all rJ appy:
11HVAC Gas Tank []Gas Piping Shutters ❑Windows/Doors
Electric ❑_Plumbing Sprinklers I Generator ❑ Roof Roof pitch
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Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ �, y-f b Utilities. ❑Septic " Building Height:
OWNSR/LE55EE °f ` CONTRACTOR`S `rk
Name } \o6 b2�--e. Name: t:&o
Address:5 al a &\/d A f �Se t7[—i\/'e Company: TTup_ U-Q,
City:1?S Lr State: t Address: 4 W( _L) S- �e_4
Zip Code:`3�}�t��P Fax: City:��t- Stater
Phone No.'-?-? (7�o- 0(c 3 Zip Code: 3q a4 Fax:
E-Mail: re-V ' Phone No-sw_ 0q I-1 — 4 Lot b
Fill in fee simple Title Holder on next page(if different E-Mail:+We_`�e(ykIjL.LC'
from the Owner listed above) Stade�CCo'unty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAWxINFORMATIOV '2
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:_
City: State: City: I State:
Zip: Phone Zip: Phone:i'
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. i
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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 your property. A Notice of Commencement must be re rcld-and posted on the jobsite
before the fir In ection. If you intend to obtain financing, consult wi en er io an attorney before
comme n r rgco_rdjngVour Notice of Commencement.
Sign re wnerDIASTATE
essee/Contractor as Agent for Owner Signature of Contract /License Holder
STATE OF FLO jr OF FLORID 1 i
COUNTY OF 6T • LUCI(, COUNTY OF �'1! LuCI�
The f�gginginstrument as acknowledged before me The forh�ing instruzent was'acknowledged before me
this 2May
of Seg t� 20 I -7 by this U day of 's 1 200 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification I— Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L_ S)L 2 LJtA Produced -k'- "C> Z-A I1, t�j 2L�
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Y d/ EL"
(Signature of Notary Public-State ngh (Signature of Notary Public-ittate of Florida)
//��//nn �NOTARy PUBLIC David Singh
Commission No4 S.~TATE OF FLORID Commission Ndz � NOTARY PUBLI
GG083932 STATE OF FLOR
Expires 1/28/2021 Comnpit GG063 2
es 2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17