HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA41LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `� Permit Number:
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�';y.;
PROPOSED IMPROVEMENT LOCATION:
Address: { - ZJC) -
Legal Description: A r G Ca
Property Tax ID #: 3`14 Y 7 0 o In Lot No. csl j
Site Plan Name:/1/V ►l 2 L- 0, 1,Q Block No. ( _
Project Name: CC )c_ M VIY-\
Setbacks Front es Back: _Right Side: _Ij� Left Side: r, % I{
DETAILED DESCRIPTION OF WORK:
2 l)V 2 ��► `�i'►Y�R ��l �Y1��i `U t G.-r,Ct i- �a
n 4C
CONSTRUCTION INFORMATION:
Add itiona I work to bffr orme un er th is permit - c ec a
1_1HVAC Gas Tank F]Gas Piping
11 Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ (O U OU > 4�' V
apply:
_ Shutters Windows/Doors
Generator ® Roof 3 `- Roof pitch
S. Ft. of First Floor: !J %74
Utilities: Sewer L Septic Building Height:
OWNER/LESSEE:
Name j;i�1 �dl yv „�a:,�c, j Mc.c, Iv n l..l�►ac_vti,
JCG 115pt
Address: 1`1�.
City: State:
, Lv i State: I -
Zip Code:3�-i c1 S J. Fax: A/.L4
Phone No. S (, 3 % - �2 el6
E -Mail: 11//4
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR
Namc.
Company: -�, - S L, L
Address:, S 5 - t c U!s, C, _�S_+
City�Uc-A 'SA- LU C 1 t State:
Zip Code: 3cl ci'sl Fax:
Phone No.
E -Mail: lou cbr15PfA5Kvi7_%/ 0 Qyt�lc:� •C0�
State or County License: LC C / 3 -;.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
004w_. -
DESIGNER/ENGINEER: _ Not Applicable
.]j
�8��IIM,�Li'
MORTGAGE COMPANY: _.)d Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Jj, Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
FRONT
ZONING
Zip: Phone:
Zip: Phone:
VEGETATION
SEA TURTLE
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 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 our Notice of Commencement.
�G
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
RECEIVED
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF 3�. L_cJ C;/ -Z,
The forgoing instrun ept was acknowledged before me
this [l day of 20� by
The fgrgoing instrumgnt was acknowledged before me
this �L day of /�-✓�.A 20/
y by
w �.f.� 1:�11�CiS �cnS.c►�
�: l ✓.►�- ���3 (..=`1�/J �tr�:�(. �,
,�c��d,
Name of person making statement
Personally Known � OR Produced Identification
��
Name of person making statement
Personally Known � OR Produced Identification
COMPLETED
Type of Identification
Type of Identification
Produced
Produced
66
(Signa re of Notary Public-�tv�,o orida���
yP : •..,. � 7�RK KENNY
Commission No. * �°#GG 144499
Expires September 19,2021
(Sign ure of Notary Public- State owl ida )
tµ�r due�� MARKKENNY
Commission No. Con#GG 144499
. or Expires September 19, 2021
Rev. 8/2/17
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED