HomeMy WebLinkAboutBuilding Permit Application I � i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: OZ- I ]Cp Is Permit Number:
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Building Permit Application j
I Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 I
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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ERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCA'TIO`N -
Address: CQ I I(.P +,-Ur nPLA✓1 12fd-C 4�-i- st 1s!�C,C Z-11tgB(O
Legal Description: rnako d S- on-e, 1 P8 &I-3_I I Ll�t S / 0K 2-l5o —3RU
Property Tax ID#: 33 as - ,5 Q j 00 1f —000 Lot No.
Site Plan Name: I Block No.
Project Name:
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Setbacks Front Back: Right Side: Left Side:I
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DETAILED DESCRIPTION OF-,-WORK {r
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CONSTRtJCT10N INFORMATION ll'
t ona work to be nerrormed under this permit-che,1 all appy: I p
HVAC _Gas Tank ❑Gas Piping _Shutters Q Windows Doors
Electric ® Plumbing Sprinklers Generator I_Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:'
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Cost of Construction:$ Utilities: _Sewer Septic ; Building Height:
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OWNERJLESSEE CONTRACTOR ' '
Name -';-p Phy )1 I S Name: --3-Cj� DCiS 1WCA-
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A�ddress• [ . ()-W K-IYA Eid . Company: �S P00I Sere tC2
City:
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C} �. l�Ct2 State:FL Address: ND - 2,0X
Zip Code:_ 3qagco Fax: n J GA. City: PCS--f- a"! I_uGtState:FL-
RPI $ � Fax:-7 t'S9 ZZhone No.
IE-Mail:_ n/ 01 Phone No. �?2'- �7`'j - 5co0
F,ill in fee simple Title Holder on next page(if different E-Mail: MiQk'i8Ae (P-J,(9.73 la '-fcthao <Ccu�
from the Owner listed above) State or County License: Gpe 1Lt5g013
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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ISUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION f A F
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:; Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: ,
FEE SIMPLE TITLEHOLDER: _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 the permit holder to build the subject structure
Which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that maty restrict or prohibit such
'structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
IPconsideration 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.
111he 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.
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! natur of Owner/Lessee/Contractor as Agent for Owner Signagiie&f Contractor/License Holder
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STAT FLO JDA STATE O ORIPA
COUNTY OF �jZ, ,��5� COUNTW OF �T r1 LGL --
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The forgoing instrurnefit was acknowledged before me TheLrl !nginstru .. t was acknowledged before me
this�day of by this "day of Oby
os �/ ',
Name of person making statement L-� --ITame of person making statement
Personally Known OR Produced Identification Personally Known I! OR Produced Identification
Type of Iden i a ' Type of Ide tifi ti. I
Produced 1r— Produced
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VA%IAAI\,O -A/�-k
(Signat of Publ! - orida i e of Notary ,u to
Commission No. p S a �6 P e� �. Y pw ,�p sy F t h State of o a
p.SWTIART-Wt
otar;Public.::,late of iorida fission No. ^�S ea' s �o�sssoa
" Comr i-=ior-4 FF 965 ?y comm.expirwI&_ . 0
ps .,etas Feb.2 2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
11 COMPLETED
R'ev.8/2/17