HomeMy WebLinkAboutBuilding Permit Application From: 11/13/201713:561 #085 P.001/003
I !
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1SS3 Fax:(772)462-1578 Commercial iAeside,ntial
i
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: Sli-• byC� � 4z) Q:WVAL-tA-
Lo�k"'� � �t 1 esu• c� c�,11L �Oc- ,
Property Tax ID#: 2,L�a _ 5C.50 1 a Cl a Q UQ ! Lot No.Q
Site Plan Name: Block No.1$
Project Name:
Setbacks Front Back: Right Side: Left Side:
C CIA Ci-m p
C 3 "Ccs�..�
.r—
Additional work to be nertormed under this permit-check all that apply:
HVAC Gas Tank ❑Gas Piping 17I_Shutters Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
j,
Total Sq.ft of Construction: Sq.Ft.of First Floor:
I
Cost of Construction:$ _� ��� �3 ` Utilities:nSewerElSeptic Building-Height:
I I
Name CA J� Name:
Address: r; C") 'S', -;,C,, C ` �~ Company: IL "I -
C, P Y� U� �-�c.:3
City: ' �)Cl..u_�p• State� Address:'5u ldJ N-0,-_4_ nk4z I 1-u)-
Zip Code:"3�kc'1S�D- Fax: city: G ! State:
Phone No. -T-22 - ,QaL-4 S9 Q-Ce Zi Code:
Zip Fax: CSLI - \B 05�SL-�
E-Mail: Phone G S�.t •SrSI • ~1l C�
Fill in fee simple Title Holder on next page(if different E-Mai r M N� �� '
from the Owner listed above) State or County License: C CD5 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
From: 11/13/201T13:57 #085 P.002/003
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: � Name•
Address: Address:
j 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.
i 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 covbnants 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,1 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
j 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.wi fi der organ attorney before
commencin wolk-eMcording your Notice of Commencement.
Owner/Lessee/Contractor as Age11t for Owner atur of Contractor/License'Holder
j STATE OF FLORIDA STAT 'OF FLORIDA
COUNTY OF <GrD COUNTY OF.
The forgoing instrument was acknowledged before me Theforgoing instrument was_a�cknowledge before me
this f3 day of �?Q��L 20 1 by this�day of
I
`(�1 c Chr.�� ��6'x`0-•� �M��°'�;sLQ �.��J.��/
Name of per on making statetrAent Name of person making stateme t
Personally Known OR Produced Identification Personally Known r-k _OR Produced Identification
Type of Identification Type of Identification'
Produced Produced
(Signature of Notary Publi a e gnature o Notary Public-S a ?aFkpri a)S t' OI PACxt9
STACIE PAGUF� I A.
Commission No 0 r mmission No. MY CII1O-MMISStoN#I F0 B 6
� v1MISSION#FF088 56 � I`V' ��RA1 ES February 2. 8
EXPIRES February2,20 8 itpnasa-ot5:r Floridallotaryservice-c
f�Q'`I Ua'fl19 Floddallota Sery e.co
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ; REVIEW REVIEW
DATE
RECEIVED
j DATE
COMPLETED
Rev.8/2/17
i