HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J a
Date:� _��=? Permit Number: I L
:� � r✓,�? b aa,- EC E I
•
Building Permit Application DEC 13 2017
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: To Select from dropbox, click arrow at the end of line
Address: 3025 IRSSO Ltd AV ED U E- Y10" S T LU CSC EL 3E,95.3,
Legal Description: ::5 Autq A)-n�D 0 1,U 6 91,Ar Tli OLE &K 4D LDT /2 a 338-a��l+k�
Property Tax ID#: BUS- 763-53 7Y-Uuu-q Lot No.�
Site Plan Name: Block No.4_
Project Name:
Setbacks Front Back: Right Side: Left Side:
K �'�2•: �z1-.� .d' �.ha e���.'�.*3 �c _'� iw x, �'� s-...a 'c5 �t�^'-1.."• *s�-`i 3,�nu,� `�+_"x
42tl � "x✓y d aN r „s-.`mirex SeY >5.rac't"e. S `5` t nh 3`�' . x.`�j?'« ct T!. �ti
�
Yv 'T�' a"'....l�r�e%!s�..•+`�.., �t'C.+'_<H. ,tbvS Y��as�_:��.tp �IL .aYX3:cr��u.f-.ue:4::...�
� ,� _ ��, '}' i a"< jYr'�2.w'+'-��c`x`�`'z-'�'.3� 'x��"�.r"}.��`5� 7.t»�r(r`�1r'�fi.�'t `'s +Pio-. �a•'a4;.;+f's -•*�.��fia��1"ak �'Y�"" _.',
Additional work toe pertormed under this permit-checkzheck all tbal appy:
HVAC OGas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric El Plumbing Sprinklers E]Generator �Roof t3 Roof pitch
Total Sq. Ft of Construction: �� -1 S . Ft.of First Floor:
Cost of Construction:$ , 7 Utilities: Sewer E:]Septic Building Height:
�
r +.�
�S; �"g.
Name ."rlluxn Lyn skin Name:
Address:33"75 7r",,)WQ02 An—, l.�L Company:
City: --Ute 4r 3r- wc7i� State:I& Address: I ,(. e yr,ell e r C[Jr
Zip Code: S D, Fax: City: ��� State:
Phone No.--LIP- �j d�- �V/ Zip Code: Fax:
E-Mail: ,S i alai !L e [Q ST. Phone No. "1 J, Z
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: D
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
kf ..�+P
SLIPFLEMENTALCONSTRU'T�TION1LIEN�LAW(INFORM%ATION fi x Y >`; , � ' ' T' �?s
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.
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 thepermit 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.
ae�c CA,c 31�W_'r e_
Sig atu a of Owner/Less—ee/ContractcVas Agent fo66wner Signature of Contractor ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1 j LW.M— COUNTY OF 5T Lucxe
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Wi day of (bet44%heA 20JI by this '46 day of l e'C2M&J, 20L by
k lees S. SLID
Name of persoA making Itatement Name of person making statement
Personally Known OR Produced Identification ✓ Personally Known ✓ OR Produced Identification
Type of Identification DL Type of Identification
Produced 4!530- i) - q3-SO- Produced
(Signatur of Notary Pu lic-StatA of Florida) (Signat re of Notary ublic-St to of Florida)
Commission No. oGrb��3 ; �" Seal) DEN189LMY Commission No. b91 oon!4Seal) pEN18ELEMAy
*MY COMMISSION#GG OMT6 *MY COMMISSION#GG 0
5 `aQ EXPIRES;March 23,202 Nr oe EXPIRES;Match 23,202
mmel Irim""Notary SN am �F FL ed Thru Budget Nomry
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED L T L
Rev.8/2/17