HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j`�
Date: 3_l AY Permit Number: / Fos
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Building Permit Application
Planning and Development Services LIAR — 7 2018
Building and Code Regulation Division
2300.Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential K
PERMIT APPLICATION FOR: 74iOm
RR,0P SED INPROUEME4NT L®CATIO'N:
Address: 1085-1 S. Ocean 9i- #Ad ,Teofeo vReacA, F'G.V?5_7
Legal Description: Wma,*,// V,//ag t li v td e --ret C62A. /Yo 1 unit 163'
5--90 209: 710 8YY-2 98y ongl 12986
Property Tax ID#: g5-11'y1Q-O17,' 000- Y Lot No.
Site Plan Name: /Wi-nel'y,`�1 Block No.
/
Project Name: O T
Setbacks Front Back: Right Side: Left Side:
DETAIL ® DESC"pPTION 0"F WORfK
CQ,r,_ l��ern0�i'7��4 n 9h rtrr�a vG/ O X00 eJ,;Ie
o i iJA rody"-
C®NSTRl1CT1.0'N IN'F®RUATION:
Additional work to be performed under this permit-check all that app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: BOO Sq. Ft.of First Floor:
Cost of Construction: $ ?l00_ Utilities: ewer _Septic Building Height:
OWN�ER��L�=�S�S�'E: GONTR . TOR:
:Name,3omes.G. Jr- -rwJ SvS«n e4er Name:, ; ,�//->>o`r!
..Address: 377 Whny."�/'• Com.party.;./ lirec0r/n %iJC•
City: ' o� .e.t`" r= f�f//! State:Jy7.rT Address: �1-
Zip Code: x eT, 307 Fax: City: J nral 66a`i State:�L
Phone No. ' `7 - 7$5;S Zip Code: 75191 Fax: 771
E-Mail: i nhe Aer GDI. W/,n Phone No //77,)- -..VO-37/
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP�PiEMENTAL CONSTRUCTI®�N LIEN LA�l1/ IN�FORiMATI®`I�:
DESIGNER NGINEER: _Not Applicable MORTGAGE COMPANY• _Not Applicable
Name: Name:
Address: Addres
City: State: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ pplicab BONDING COMPANY: Not Applicable
Name: me:
Address: Addr
City: City:
Zip: Phone: Zip: one:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the wo nd 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
commencing work or recording our ice of Commencement.
Signature of Owner/Less /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA I �I
COUNTY OF � n COUNTY OF 1�`C�-��IS/I
e forgoing instr ent was acknowledged before me The forgoing instru ent was acknowledged before me
this ay of 20]?, by this day of 20by
L S �
(N a of person a no le gin ) (Name of person ac now ledging)
(Sig re of Notary Public-State of Florida) of Notary Public-St a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif'catio Type of Identific L n
Produced _
'� b- Produced
►� - �USHEAL GROGG o�VRYPo'e4 DSHEAL GROGG
2 ,...... n ,,,�,✓
Commission No0Bwt
��/,�1�3Se MYCr IMISSION#GG 080413 Commission I5PAMISSION#GG 080413
RES:March 7,2021
'*QF F�°Q
° '3 °� EXPIRES:March 7,2021
9r �Bonded Thru Budget Notary SeMces
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
re-v—.7/2014