HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED --1
Date: 1 �d 11 Permit Number: G Go
7VII
Building Permit Application 2C _
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 BYE """
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential k
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6n WoW_deft 9(.
Legal Description: 08 31"3q Thar VaA of 5E '14 .:If SE `14 OF 064A LtiG s Ara, t of Cjart& Parrs 5.1p-Less c4ftA t
—_art ¢o VA) Y-97 ) 11)4- 3735-/x,'3)
Property Tax ID#: RX"6-4AA- 0002- 000- 1 Lot No.
Site Plan Name: Block No.
Project Name:�(► ysselW��
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: e--,fpp'l-
'RcxoaC, e."y't'"S YL'aflr� 4 insdatl a far 1 sh�nSlUc'a� n� sy Sd ars
roo F p1-&A 5"/l s lope-
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit-check all appy:
E]HVAC Gas Tank Gas Piping _Shutters a Windows/Doors
❑Electric ❑Plumbing HSprinklers ❑Generator &I Roof Roof pitch
Total Sq. Ft of Construction: 1300 S Ft.of First Floor: '2�
Cost of Construction:$ 0.11-00 Utilities:n Sewer❑Septic Building Height: 1 L
OWNER/LESSEE: CONTRACTOR:
Name Uy!cS" Mu5Se.ly %w- Name: 14e#114a 00
Address: &o kbod.C^(CJa,, VC. Company: ek1kc ACLoofir)q —tyiALv% tic_ .
City: (i (k ' lam State:_t), Address: 4k'L- sG WiWv) *,If-
Zip Code: 31kgAV Fax: - City: -xv f r State: Fl
Phone No. - Zip Code: 3a9gA Fax: -
E-Mail: - Phone No. z-
Fill in fee simple Title Holder on next page(if different E-Mail: �� oFtrc�t
from the Owner listed above) State or County License: C ct�sso�13
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE 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: 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.
ignature ner see/Contractor as Agent for Owner Si ature o on or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF /�'? 4
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this day f lJoyefhbe,, . J2 20by this�dayof ✓Gfhfbfi�' 20-1 by
" /~
("'ne'A
Name of R59on making statement Name of person making statement
Personally Know OR Produced Identification Personally Known X OR Produced Identification
Type of Identill ation Type of Identification
Produced Produced
2c•�it L�t�
(Signature of No (Signature of Notary Public-State of Florida)
Commission N -'STATE OF F�� A Commissi Y Theresa Anne Fasan$eal)
tlomm#GG12627 6fiMINT PUBLIC
•� 1�. Expires 7/19/2021 °` -STATE OF FLORIDA
W� EXn 7L
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATk Nire RIAMPLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17