HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services FEB 2 3 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential 1/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
0z 3
..,, •,. l� s t rs+ f dyW .s
ew ;} ,G„ �,a .� _ '� 11 vs 4
..z,-a :.;.,5�'cy,.�^,<'at.r..i�if�_:`k ?rYd:v'.'.;rYoid....2-�c,PT:tL`...:,. ,.{ ;''41. ' •'- iL-i`•'t,�r�w.x-_•
Address: .1-1200(RSC% b u�
Legal Description:UV A n 7 d d L[e l3- /fL AT 7 t o0- 604 010 -40-r I (Lg 3ag6 4 6-75)
PropertyTax ID#: 3 q RS- 90-Q- 005-5- DDb-- a Lot No._,�
Site Plan Name: Block No. Qo
Project Name:
Setbacks Front Back: Right Side: Left Side:
ati "_' '�'-.:a,Lr'_.- Yom,%''. x•., a.-�;'7` -" ('a� �f moi- ."'�'1<- `:i�"'1'�' zia e, p�r„a i� }si<'�a �,a�r?,�''esrJa-n-k�.r i?i"�t=- - �" =
�� ,1+ rS" c;ev. �l 6 r� .f�i.}�; 1"CY S,�~`'ty t 4�4 `� '6`•-Chs '� g 5• 'xr
A- r„ ..r3'5 ;-• "rY.a< r'C a T z,'; 6 �;'u.'�.a� '�•3Lt"±, yF� t' !S-,...
-.+.. `� ". .�li�.ra.'i.�"f`�,••.^i�?� .:.t..1."T; +:>,:N�?, .�.r•��..,-:ie'.Y. 1 •: �u: -w '". �Y' �,'�fi`•r `#.. k- ra�k,ra. '..,51'-x-fix'
.rtfi+::��.r<:�..+Y. la-...+,ri: Su 1.-...;.a,.. ♦ s.�..w�S`+::.fl+ �.., i\
7-'79 K 0(F.
�p � r`-C-Ld}c�e .`-��W+t�-�'�o.�f+{�"'q�t°C*'Y �„13�'0•.�JrG�V 's h_ },... F� '�rif �•}�q�=i��
- �.; -. �ss ;.. n. •� F �.i�" ; ,` ��,�. G'ta,� 1 t ��L >,�-rr !�`� r_13" s'�`s.�• 'ch ..L
?�: :�,_ :� F��'aT,rx /`��4���_...��f���-, -t�;;z`.:�.:J�xr.±'ai.N.�d�i:Ct 3..�„are�• .�u_`�k_^..«r:.tr,=,. ,.rwa.t,'k:-��,�� "ftzCr�•.�r+"��`.��art._ _.u�t.:f ie'w
Additional work toe pertormed under this permit-check all appy:
HVAC 0 Gas Tank ❑Gas Piping Windows/Doors
1 _Shutters ❑Electric 7 Plumbing ❑Sprinklers E]Generator 12 Roof I a Roof pitch
Total Sq. Ft of Construction: 1200 S . Ft.of First Floor:
Cost of Construction:$ ''%, �Sd.�b Utilities: Sewer Septic Building Height:
6 ;. 'S
�"$-
Y+ � 7 ^y Ss�.' S lr`c.� FX °J' 7* �,5 r�- .}t•. 'Si-ya,}a�w�� �'c;
"a.�.^= -c..- i_"_'�-.£.^z�1rc'Sr��'�k..f.'l<..- ....°YdriG+. xi1 �5�:cM.d ?k'\.rt.Fx�W�:'riL �e.._.++tf.X•�l�CT::`i:.:a' .. �_ m�.T ���:S��s=.
Name_10015T 11A60r6TI" Name: --?5,e JD '', llb,rgld
Address: 391.3 3'90I),b(V.b Atmoue- Company: C'�1�I��IVAL l�DF �S(r �fyrNG
City: "PpOT 6-1 LU.cyc State: Address: /�b/ 50 S • 0,10M�Y4LX CT/lC/e-
Zip Code: Fax: ---- Cityr:a I",-,7- S7- Laac State: FL
Phone No. /aq20 Zip Code: 3y-q2' I Fax: x.35-9555
E-Mail: 1,12966c-TI"E AL. &M Phone No. _X35- 95So
Fill in fee simple Title Holder on next page(if different E-Mail: &-mgx e- 2,911 AmMy r-sA)&,lk
from the Owner listed above) State License:_j I(7 0 0.3�?_513
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU,P�F�LE�VIENT�►L CONSTRU"CTI'ON�tIEN��L41N INFOzRMkA�fION �,'� � a� ' �t �_�r { �}�}�Y t ��`��z'
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 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
comm e cin work or rlicording your Notice of Commencement.
r
Signature of wner[Le a /Contractor as Agent for Owner Signature of Contra ctor/Licen'st Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF '�_ST COUNTY OF_jE ZGIC��'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,(�idayof `JAVI HILA 201' by' this dayof �l'YIUA/ty 20 1? by
4du i S-e Ag9ue L- 225 2A-1) 5 - A66AA)
Name of perso making statement Name of person aking statement
Personally Known OR Produced Identification Personally Known rOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatu•e of Notary Public-State of Florida) (Signituri of Notary Pu ic-Stapt of Florida)
Commission No. ZL, b773 jo rot DENISE LEMA Commission No. (S 0r 6117376 -*'f p�.B'e� DENISE LEMAY
* *MY COMMISSION#G 077376 * * COMMISSION#GG q77 r6
EXPIRES:Mardi 2024 9FOF Fg EXPIRES:March 23,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17