HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�1 Permit Number:
I's , 1� .�y =01818
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Building Permit ApplicatioPlanning 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
P ENT LOCATION:—
Address: 4pod)o '6J*e0-1 h i t V C_
Legal Description: I nCGRt U e(- 0,54- -i cS (Jt t+- $ 6 i K-- & 1 Loki 7 -e g-
Property Tax ID#: .34`101;1 " 4 04 (�to I J �� �- Lot No.
Site Plan Name: Haz Block No.
Project Name: J+ �
Setbacks Front & [ Back: Right Side: Left Side:
1,2Y.A.ILED D affisam`.CRtl?TION oMMUSOMMF_wQR C; 11111mgimi
-?C, -f4- o 444- h r�h 0-h rk i n ti)K- I n c at+f-% Ko 44 kJid,Q, t-E (j( = I c
CC?NSTRUCTION INFORMATION:
Addit-ion8l woo to e performea under tis permit-check a appy:
HVAC Gas Tank []Gas Piping Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: 0Sewer []Septic Building Height:
OWNER/LESSEE: CONTRACTOR;
Name T— t &J, f Jc1.` k c Name: (2A [d-t) M&-not,
Address: nn/nD �1 CL U01O-A k 06L Company: 5--civ f rcnC-e.
City: min7L_ State:joiX Address:
rQ"O._L,i�_DX- (03(0
Zip Code:4f3 9`1 Fax: ! City: 5�t-�.�ur L State: FL
Phone No.,-24:F- `7 . 3�'`r� Zip Code: Z 4-17,75- Fax: 97.2 aYR-30.35
E-Mail: Phone No. / -o - YF—,V-MI 15-1
tLLi'�'�C� &
Fill in fee simple Title Holder on next page ( if different E-Mail:54beAISDCt4-A • f'le+
from the Owner listed above) State or County License: AQ 97F
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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 toyour pro erty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspec ' If you intend to obtain financing, consult with lende an attorney before
commencin k o cording our Notklgbf Commencement.
Signa Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1�3')QY ><1 v1 COUNTY OFf 1T^�-t Y)
The forgoing instrument was acknowledged before me The f__o�rr ,g.ng instr ment was acknowledged before me
this Lay of 2011 by thiscJ��day of 0.,1 Li,O-a^Ll 20j,�'by
Name of person aking statement Name of person making statement
Personally Known�OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary P jb e of Flepids (Signature of Notary Piihlw -
_� DAN K BOND 0:_ DIA&E BOND
Commission No. Commission No.
MY C SIGN#FF185430 MY cOM �N#FF185430
EXPIRES December 28,2018 ''�E '' EXPIRES December 28,2018
(407)398- 153 Floh(JAN1pi S'.rvi
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17