HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �d11� 1 �"� Permit Number: V1 1d'da39
RECEIVED OCT 1 202
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 T
PERMIT APPLICATION FOR:
I�ROPOkC 4"%0'V II�IENT Lf3CATIa�V
s
Address: 9 C» 7 G0Alclll Ick
Legal Description:
Property Tax ID#: '�y0'�" S dam` , d oZ� 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
z
Q "TAILEM CRIPTIUN } INC}RK
u30 G-AZ 5Np2r6 A- 1CzAZg,44-4C4 -�
CC#1VSTRllCTlON INEORIVIATON s
Nonal work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric 'Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction:$_ 52'00 Utilities: —Sewer _Septic Building Height:
OINNER/LESSE _ CO TRA
CTOR� �X�
y
a
Name- L c2 /c.A711/ ,l'4 .4 Name: 61)7712JlL1I G.LL
Address: o2CJ7 ��'� P,o � �1. Company: &/Gd-✓,4/2-75C�,5 00&IAG.A:,"R
City: State: /�G Address: 15-1) 6Z'04' 35b4/;LgIf4
Zip Code: Fax: City: g=;C6A149,461) State:j�
Phone No. 772 S:La 7 3-7e Zip Code:�S� Fax: Z:Z ;-73
E-Mail: Phone No %/7y Z;7,9' 1114)
Fill in fee simple Title Holder on next page(if different E-Mail SCc I I�'>s����7���- i✓I P f
from the Owner listed above) State or County LicenseL
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPF�LEME�TALC[�STRUCTI�C}N LIEN LAW INC3RMATtt �R � � a
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _NotApplicable
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: 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.
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Signature.of Ow er/Lessee/Contractor as Agent for Owner Signature of Co ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Ly C'\e COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this %\ `day of `Q 20_q by this"day\of 6c.1 20-q by
� � G `ha r-J 'Schoc,t.,J q�a�{ 'R�c1�w1'd. S��►.o~c: �n.Jg�d4.^r
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known- OR Produced Identification
Type of Identification Type of Identification
Produced Produced �L L
(Signature of Notary PuMi - (Signature of Ndt
p�NNAMARIEGIVEN5 ( g k�lic-Sta��blfV f�Rfit>6m)VENS
�� `" MY COMMISSION#GG 022023
dISSION#GG 022023 ; ;
Commission No. 1� 2020 'iCommission NJ F Es:Decam �o
December 16, ���
r"�• .� '� PublicUnderwrtera nrNotaryPu icUndevriters
Bonded Thru Notary _ .T.
REVIEWS FRONT ZONING SUPERVISOR- PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
:Fe—v. 8/2/17