HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED L
Date: S_L� D 1 I fy Permit Number:{ -1
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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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 77 C ze--n boif f— CI12Cte-, Pod + ,ICC�'
Legal Description: Poli i Q PUD It rcen.eP ( P13 41 -5 -') 2 0 V_ 314B -I`ve,
Property Tax ID #: ?J?j as ' -700- QQF7- cco'-q Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e eG+(-i C i)Cv1 Oc(�L R -c Iace w -c- l I ILS
CONSTRUCTION- INFORMATION:
Additional work to be nerformed un ert is ermit - check a appy:
HVAC Gas Tank Gas Piping _ Shutters E]Windows/Doors
Electric � Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ '2-(!:� ,0U
S Ft. of First Floor: _
Utilities:OSewer OSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 'f"oL YV1.5'"c
Address: _7-7 S e
Name: Ck l Via -
Company: DaQ IIV_C(!s Lr -_b01. SCOVICE-1CC
City: pc)(1- cl�,)- L IACD State: -I-(_
Zip Code: 54Q BU Fax: n I C -
Phone No. 301+ -.L4 S '-^]-7Q�
Address:P-Q . 90f, E§� E55
t�
City: o ri-c� St: Wa-t✓ Stater
Zip Code: 34 ?>? & Fax: i7z-LD1- ZZ
Phone No. -7l2_ -(Rira - ECQD-7
E -Mail: C,_
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: i'Y1t C h OJ -C 00 ILO -73 F tWiQO m QQ Y1
State or County License: Cpc, I L5 q C)l3
C-echqade--t 30545
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
;SUPPLEMENTAL CONSTRUCTION LIEN LAW INFO,RMATIO.N:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: X 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 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 vour Notice of Commencement.
Signa a of wner/ Lessee/Contractor as Agent for Owner
STATE OFF ORIDA
COUNTY OF
The,f�orgQing instrum t " as acknowledged before me
7►
this day of I c Y�-J20JZ by
vls� -� ,I, �v�
Name erson making statement
Pers ally Known OR Produced Identification L�
Type of Identific tion
Produced L IJ L ft
(Sig Not Public- Sta4e of Florida')
v
Signature f C tractor/License Holder
STATE OF FL IDA
COUNTY OF
The f rgQing instru en was acknowledged before me
this lday of 20 �� by
� j� V-0
Name o son making statement
Personally Known OR Produced Identification —C—
Type of Identif�oa ion, D L
Produced . `}�
of Notary Pu- clic- State
Commission No.r—IR—MA
r+Public State ($0grida Commission No. l! �tal'y Public Stag (orida
. MAYNARDlR1 J. MAY COM
# FF113673 My COMMISSION # FF113673
gXPIf��S: April 16, 2018 EXPIRES: April 16, 2018
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17