HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l 11 /�
! Date: Permit N umber:i [ l a -10303
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Building Permit Application ss I� s3
Planning and Development Services ,� I,, erg I�{ 'a-1
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax: (772)462-1578 Commercial 1 Residential x
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIONI€I:.. '
Address: S S 10 5 (6le, r I''h
;Legal Description:,-. end;',�•, �Z. vc r• C S f ff ie S U(► 1 ��., Lam i /J k -)3
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Property Tax ID#: 3L4O 0' G I0 - 00q)- O0O/.7 Lot No. �-
Site Plan Name: ! Block No. 3
Project Name:
Setbacks Front Back: Right Side: Left Side
DE1'AILE;D DESCRIPTION OF WORK d1`(
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tJ �lcGAc j sS✓es o � v Cole- � �j �`5 vAsiJC/ VAl,rso2�e
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lbf f,/4r A Plinec. (!S fC' 3-0) lb0)Ce5 'A 41.1• r cj, ,rk r1r-, Cd..�C;:t
CONSTRUCTION INFORIVIATIQN 3 i €� '�
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Additional work toi e e orme under this permit-check a apply:
Y: � I❑HVAC; E]Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
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Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER%LESSEE r CONTRACTOR s7
Name Name: C2,�
iAddress: Company: & L
City: State:_ Address: /20 /31>e gd 1-3
Zip Code: Fax: City: S c; J,��`�;tx! Stater
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Phone No. Zip Code:3��il f— fax:
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E-Mail: Phone No. 7 7 .7-I1'9 7l 7 7 � /
Fill in fee simple Title Holder on next page(if different E-Mail: Ptt A it 3Z%i %h�Ic�� 7r/V--
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from the Owner listed above) State or County Li Ilei
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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: �I
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
J 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 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 Almendments. 'I
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 wit le erpr an attorne of-
commencing work or recording our Notice of Commencement.
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Signature of.Owner/Lessee/Contractor as Agent for Owner Signature of Contra for/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF I W_
The forgoing instrument was acknowledged before me The forgoing instr ment w s acknowledged before me
this day of 20_ by this day of ) C 'Y _!__,201'i by
C-1' 1W 'UU11-
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known I OR Produced Identification
Type of Identification Type of Ide tificatio'n
Produced Produced �L�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-;State of FI id3t�; ;,�.,, TIA MARISSA R TFIN
MEL
�� ; Notary Public-Ste orida
Commission q 1S14
Commission No. (Seal) Commission No. I .4 Commission v:' My Comm.Ezpire 0 ,zoz1
' ;;;, HondedthroughNalio al ryAssn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ! SEAITURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE it '
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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