HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
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
Address: �9 Se CA-MIW S7'_
Legal Description:
Property Tax ID #: 31419 - 0,9-7-5-- 000 —
Site Plan Name: $ p
Project Name: P'vs\J
Setbacks Front Back:
Right Side: Left Side:
Lot No._
Block No.
EL�CTkfCAL W,k�14IG F04 A/Eu/ AC OJ 17—, (-1C- ICU;_00z
CONSTRUCTION INFORMATION:
Additional work to Up performed un er t is permit - c ec a appy:
HVAC L I Gas Tank E]Gas Piping _ Shutters Q Windows%Doors
�Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ —5 -WO)
S Ft. of FirstjFloor: _
Utilities: Sewer D Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR.
Name ELI -Eq gElZdfi l
Name: KTpor' �1 RNPJ
Address; a0l <2E ['t F }r1JO !
Company:fiCCl% 1T�C)k/ ,t/ C(3ni"jkt)CTiN�, �iJC
City: _ _ QP_ S7" Z -Oe eE- State: FL-
Zip Code: 3g9-5 Z Fax:
Phone No. 77a-_�- 7e--� 171
Address: 7/73 GAO- Tl Pl-
City: 1005zr ST ,Luefc State: 15L<
Zip Code: 3q?5_�Z Fax:
Phone No. 772- 371__-5-75.5
E -Mail:
Fill in fee simple Title Bolder on next page (if different
from the Owner listed above)
E -Mail: /J(rV AJT ELfC-T R1C PS(- P -OW -WOK, C01
State or County License: 6C 000 30 7a
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
L F EN A C N TF�U :TION I�� f �.AI t.INFtJI?►1U1 1`� N:�
Name:
Addre!
City: _
Zip: —
(NEER: Not Appl
State:
Phone
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:,
FEE SIMPLE TITLE HOLDER: T Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
---State:
Not Applicable
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 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 fist inspection. If you intend to obtain financing, consult with lender,�r an attorney before
commenciAb work or r4 ording vour Notice of Commencement.
Rev. 8/2/17
Ile
Signatu o Con ctor/License Holder
r/ Lessee/Contractor as Agent for Owner
Sign ure of O41IDYY4�
STATE OF Ft
STATE OF FL RIDA ,� -
COUNTY OF -
COUNTY OF r LSC -('i
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
201 by
this "day of 20 /� by
this day of
Name of person reaking statement
Name of person makill statement
Personally Known t9 e OR Produced Identification
Personally Known _,%, R.Produced identification
Type of Identification
Type of Identification
Produced
Produced
f 1
a�C. VIII ��/i�
(Signature of Notary Public- tate of'AiI(/� �*"
rj
{Signature of Notary Public- State flori��i1ll����f+`llly�r
�5 G. VIRGi�
`�X ......-,
Commission No.(Tf�/3%10.7 �R O ;.
'% a V
Commission No.(Z10710�O���
REVIEWS
FRONT
Z � ear d
jDdea
PLANS
VEGETATION
SEAQ ' MANPP,141 �
41
COUNTER
un
R #'
REVIEW
REVIEW
. dedht i>1iI��
p
DATE
grn
RECEIVED
DATE
COMPLETED
Rev. 8/2/17