HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A9-5`17 Permit Number:
,�:_ _z
' �CEI�'�D OCT 0 201
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: �P,-►��l�tjon
PR PP'OSED INP OVEMENT LOCATION:
Address:379 Oki &vel 8&41, R, _71-19i-7
Legal Description: Alf//l-ii -�S�4�A J7--es, 5-3 5 /719
Property Tax ID#: N5-D,2- 5"ol- 0rd -OoQ' c7 Lot No. 379
Site Plan Name:�1�V#(if Block No.
Project Name: 379
Setbacks Front Back: Right Side: Left Side:
DETAIL.E! DESC + PTION OF '0'R�I<:
4.
CO'NSTR 'CTION fNF®. , .�ATI'ON:
Additional work tone performed under this permit-check all that app y:
_Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Coristruction: 67 Z. Sq. Ft.of First Floor.: X7,2
Cost of Construction: $ 17004a Utilities: 'Sewer _Septic Building Height:
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0 ' 'NE� /LESSEE. CON R CTOR:
Namer ;;:^,-. atr.:re'%4<;. ✓1/ei✓Q Name:
;;J t' clhz�si;Jv.
Address:n �'9a D% �I f�: Company
City: S�� Gi•i�i 0i +�," Stater'' Address' /' 6111 Sf•
Zip Code:, 0) d d y Fax: City: n � Stater
Phone No. ,772 -2 09- QV.7 Zip Code: 3'/9f Fax: 771-2 3'2/9/
E-Mail: Phone No 7 72 2,dO ` 3 757
Fill in fee simple Title Holder on next page (if different E-Mail Q 4h� � �'AC �/D�i�o•�a�
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR CTIO LIE}N LAW IN FORMATION:
DESIGNER EN R: _Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zi11 -p: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applic BONDING COMPANY: Not Applicable
Name: e:
Address: rAddreCity: ity:
Zip: one: Zip: ne:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work ' stallation 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 o ner/Lessee/Contractor as Agent for Owner Signature o. C ntractor/Licens o er
STATE OF FLORIDA�,//fJ STATE OF FLORIDA
COUNTY OF .-/7 407,-AI COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-rday of 06r 20/7 by this day of ,20_ by
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(Name of person acknowledging) (Name of person acknowledging)
(Si attire of Notary Pu ' - tate of Florida) (Sig ture of Notar ublic-S e of Florida)
Personally Known OR Produced Identificatiorx/_ Personally Known OR Produced Identification f
Type of Identifi ation Type of Identification
Produced a rv�_ Produced FIS
•�
-DAVID c �� SHEPHERD
MY COMMISSION 0 GG 052274 MY COMMIS G 052274
Commission No.- ,�* Commission No. ���n
r ow EXrII���e No r 4,2020 „ c EXPIRES: eeem 4,2020
FOP .o Bonded T1uu Budget NotarySeMeea ��°GF/�oQ� 9orAW TMu iudpn Notary BeMoes
REVIEWS FRONT ZONING • SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED . • _
DATE
COMPLETED
ev.