HomeMy WebLinkAboutBuilding Permit Application G'
ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` � Permit Number: �f� —!� 3S
66, 6
Building Permit Application
Planning and Development Services MAR 14 2018
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 IMP,RQVEMENT�LOCATION
Address: SO � 5� ���Pt L GQ✓L a,.2`2 rM."r
Legal Description: C �t- fJ� I I` L S—
v ZZ 7
Property Tax ID J!:1 OCDCP — Lot No. �.
Site Plan Name: Block No.
Project Name: 0 5 QQ__�
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIPTION
cO/F WORK.
4Li 3- qc» Jpl i� Jt}sy�Gvl tel. ,IG JY G /z J`�U^ l f9 Vn� J Ql 1�j 575��v�.
1
CONSTRUC ION INFORMATION: ,
A itio or to e e orme under this permit—check, a appy:
C rl Gas Tank 0Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
d
Cost of Construction:$ � � Utilities: _Sewer Septic Building Height:
OWNER%LESSEE CONTRACTOR :. y� ,?
Name s �s7�- Name: Muco V. 1��Hf_
Address: Company:
City: PS State: Address: C
Zip Code: 4f Fax: City:�` zv�«Tn�� Stater
Phone Na7�� Z —z,5��f Zip Code: 5qq I- Fax:
E-Mail: Phone No. 7?r' �4n fJ 5`
Fill in fee simple Title Holder on next page(if different E-Mail: A'f(&VaCA 61460. 60M
from the Owner listed above) State or County License: 644,/g/7-0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUP-PLEMFNr7At_yC�NS�ttU�CTtDN tk�N IAU�f.�I�t;F RNtAT,�4[� �., x � ��;� r �-
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DE GNER/ENGINEER: _Not Applicable ORTGAGE COMPANY: _Not Applicable
Name. Na
Address: Addre
City: State: City: State:
Zip: one Zip: Phone:
FEE SIMPLE TITLE,HO MfR: _Not Applicable BONDING COMPAN 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 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 redorded 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.
Signature of Owner/Lessee/Con,. Signature of Contractor/License Holder Iy'l C!j40
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 9�. Lam.Kc i�
The forgoing instrument was acknowledged before me The forgging instrument was acknowledged before me
this day of_ .20_ by this� 3 y of .20�� by
Name of person making statement hame of person making statement
Personally Known . OR Produced IdentificationP,�rs�aall�Known_ OR Produced"Identification
Type of Identification . Type of I ntifimtinn
Produced Produce ••�? •;•.� I.IRAAAAIJAt
.: MY COMMISSION 6 FF 207548
EXPIRES:March 9,2019
' JT,th°•�` Bonded Thru Notary Public Underwriters
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17