HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o6 I L;Io Permit Number:
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Building Permit Application FEB 12018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 x
Phone: (772)462-1553 Fax: (772)462-1578 Commercial --�f—'— Residential
PERMIT APPLICATION FOR:
PRQR SED IN,PR0VEMENT16CATIt7N
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Address: (� x-1-0 P441
Legal Description: iuc2a U 1,,4
Property Tax ID#: 13 01 — ol 0 O a !_ Q)00 Lot No.
Site Plan Name: H/)9 Block No.
Project Name: &1101_09r7 S+//,-
Setbacks Front 6 Back: S'D Right Side: 20 Left Side:
P
YDETAII.ED DESCRITION tF WORK
§4ucco P_IpAacto 4 A)"' L^Ae-
CONSTRUCTION INFORMATION
Additionalwork to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: & 0 Sq. Ft.of First Floor:
Cost of Construction:$ �. c�O� 6 Utilities: _Sewer _Septic Building Height:
OWNER [.ESSEE• CONTRACTOR y Y
, _ _ .. �a. ti..
Name _:DeA , 'btj ffU Name: v1d.`S
Address: 0 < t.-A6 Company: 1410 LrAz t���c 6cz, TnL_
City: 6 State:EL Address: o_!ro L: pa I?gtfce
Zip Code: -13q a Fax: City:�I�, kk State: Fl.
Phone No. q 5 y,_O qt 5 Zip Code: 3,7y 't a Fax: (lilt
E-Mail: ;0 Phone No qSy 6Y8' OR s3,
Fill in fee simple Title Holder on next page(if different E-Mail AwAy fi(. Sf, L 44" 1 -co 141
from the Owner listed above) State or County License 39 C4.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEIVIENl'AL CONSTRUCT ON I;IEN LAW INFORN(AT'I() .
DESIGNER/ENGINEER:MI Not Applicable MORTGAGE COMPA Y: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phon Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: ri
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 efore
commencing work or reco our Notice of Commencement.
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Signature of ner/Lessee/Contractor as Agent fo wner Signature of Contractor/License Ider
^o
STATE OF FLORID rL � STATE OF FLORID °r r
COUNTY OF COUNTY OFo
The forgoing instrume as acknowledge efore 65�5 The forgoing instrume was acknowledge�efor VI
this day of ,b 20 by o�Q L this day of 20� by. JieL
y W�
(Name of person acknowledging) °c=_ (Name of person acknowledging) s
(Signature of ary Public-State of Flo da) / (Signature of N ry Public-State of Florida
Personally Kno OR Produced Identification Personally Known OR Produced Identification
Type of Identifica 'o i Type of Identificatin\n
Produced (� r,J�� Produced C
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.