HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: , l ea -043`x'
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED' h —PRCIVE ,NT LOCATION:
Address:_ �20010 a ri/. �_� ✓i°. j t'�f � 1'`'t_ q17
Legal Description: 6h(y,w- 2n U' !/CfZa ur)i-+ 4(-te 1 -ptGc ► `�{QCD(Zf3��•� �2S '�
Property Tax ID#: � � a� " ?/gyp —000 — 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETQI'LED DESCRIPTION OF WORK;`
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ICON"STRO: TION-:I:NF0i7,`.MAT:ON-k
Additionalwork to be Derformedun�C er this permit—check all that appy:
1_1HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers F Generator Roof Roof pitch
Total Sq. Ft of Construction: 13 7q Sq. Ft"of First Floor: 2,
Cost of Construction: $ opp Utilities: Sewer Septic Building Height:
OWNERjLESSEE. :,. CONTRACTOR:. 4
x.
Name I�kJir�-�b In Lf 14 ho Name:
Address' ' f, Company: 0
City:__ ► ,►rCL, �` State:a Address:v^� r,Ve,e61,., � Gr
Zip Code: - `� 3YR1110 Fax: City: (—l YI fl,�L State:
Phone No. ZQ Zip Code: 3Vq q 7 I� Fax:
E-Mail: Phone No. Z"�(�f �5�(
Fill in fee simple Title Holder on next page( if different E-Mail:_M
from the Owner listed above) State or County License: C'(�Com( �,7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION; - EN LAUD INFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:' Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: i 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 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 restrictionsmhich may apply.
In consideration of the granting of this requested permit, 1 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
cornmencing work or recording our Notice of Commencement.
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Signature of Owner j LesseeJContractor as Agent for Owner Signature of Contractor/l lcen,se Holder
STATE OF FLORIDA STATE OF FLORID '
COUNTY OF Lue I e, COUNTY OFLye'ie
The forgoing instru nt was acknowledged efore me The forgpjng instrument was1atknowledgecl efore me
this 10tay of )91,t _ 2oN by this 4-10
' day of,�_ e1�YVGt�„20by
Name of person making statement / Name of person rrg statement
Personally Known OR Produced Identification Personally Known OR' 'Produced Identification
Type of Identification Type
Type of identification
Produced l! --LJ:!: 1 Q� 'Y _- — �6—eb
(Signature a r t 3F i� (SignatureProduced—
On; Sit
y"Pu�Tic aLtpvicif Ellgrida +fi
.4 :r°Oqg SOLOMON LEEiv,Y CG1Y�,,M1i8Si0N#FF 912389 �
Commis _P '� SOLOMON
Commissio lkb : ` '= P1R S:tdovember15,
EXPIRES:November 15,2019 7 y 1T' i
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 'SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
.Rev.8/2/17 --
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