HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j {
Date:21 Z.0IL^T Permit Number: �� v`e
Building Permit Application FEB 2 6 zp
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)4621578 Commercial Residential Y.
E PERMIT APPLICATION FOR: Plumbing
PROPOSE):jMF'RROVEMENT L,OCATI'ON
Address: t
Legal Description:__�-1/(- m-one_do—_Pl-a* � - RKIS Wr
Property Tax ID#: 2-5--103`Uq Q- 000 - O Lot No. ALD_
Site Plan Name: Block No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK;`.
Me. so C,1 . 40k VUO tax rec�+er�elec-hic� -~
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LCONSTRUCTION INFORMATION:
CONSTRUCTION
l work-ta b(`e�erforme un er`tfiis permit-ZFe'cR'-aT i appTy:_ `---__
HVAC I=1 Gas Tank ❑Gas Piping Shutters Windows/Doors
oElectric Plumbing Sprinklers l_J Generator F]Roof Roof pitch
Total Sq.Ft of Construction: _ _ ._ __ S .Ft.of First Floor:
Cost of Construction:$Soo Utilities: Sewer Septic M Building Height: _
OWNER/LESSEE: ry CQNTRACTOR,:.
Name,- •--�iC'.tCS__ _..._. _.. _ . . ._....__ Name: .... r...).JGl�krr"?..�i�x�C���.�_-----._._.
Address: '%'%)Ll GA1MD "" C_!Y _ Company: Rpn,pinin U4a. &S D-Il unbi!'�
City: PtV*s5f.I.•-lt4Z;C -�. � State:_EL,
Zip Code: lCqFax: City: Stater
Phone No,...��►Q�.-..� .'. .... _ _.. ... _. Zip Code:3kIG.�{� - ..._._. Fax: -
iE-Mail: Phone No. 1711. ?Vin- 12gLV?.
Fill in fee simple Title Holder on next page(if different E-Mail: bwCU� - - `�d�r Ye��klttn� ,Coln+
from the Owner listed above) State or County License:._e,,. ,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S.Up LliI�A��N:TAL ONSTRk�CTTC7N,I IEN�tA1/�l�I�FORNIAT�O:N
.., .9 '. ._ .y„•AYE -.dY" 5'Y: ..
..-' .. -.. �:..:.St ..n'•-c. .:w aid. n... ... .. .._._....e._.....
DESIGNER/ENGINEER: Jam( Not Applicable MORTGAGE COMPANY: ?C Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
II' Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: , C�Not Applicable
Name: Name:
Address: Address:
City: City:.-
Zip: Phone: Zip: Phone:
..........
OWNERI_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.
It.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 before
commencin work or recording our Notice of Commencement.
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Signat a of er i.essee ontractor as Agent for Owner Signature o ontr orjLic nse Holder
STAT ORIDA STAT LORIDA
COUN Y OF COUNTY COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2W day of_EfIaxll�Al( ,20j by this ZIP day of- chars _ 201.E by
{� 1�.... ._. tl!__.__,
Name of person making statement. Name of person making statement
Personally Known..-✓, -OR Produced Identification_____ Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced..
(Signature o N ry Public-State o - ___._...._..__._.__.. f No o ippcgtatad
�jjhh ���yyy*** Angle Pudic Stats Florida //++ ,1 tt -raw*
�024260
Commission No.� 71D2�C~� �( ) MyCw ilralonG d"iumnmis on No.4"1C �t Ip6 044
My c.mrr>i,stan GG 24960 E>¢tr+e �
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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 2J17