HomeMy WebLinkAboutBuilding Permit Application 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3-/-7-2-0115 Permit.Number: Rb 3 - 0�o
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-` RECEIVE
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" Building Permit Applicati®n
Planning and Development Services
MAR ����
Building and Code Regulation Division Pera+ittin9 Departmen',.
2300 Virginia Avenue,Fort Pierce FL 34982 St.Lucie Count"
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 IMPROV,EMEiVT LOCAT(C1N F.� , , � � `� ' 1 ,.>z� ;�fr r,=.
Address: S-,;, QA
Legal Description: POg 7`o /d/O Ld3- c) /_.o-rvS (e)R goi4-•:37/
Property Tax ID#: /3 /2 S®/- O 030 --000 - W Lot No. � S
Site Plan Name: 14,ss/cr 13�, Z4 Rrj--ode-I Block No.y3-6
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WQRK ' ' '
P%u,.,ab>•r �a�ish �, �'ni'�J F,'i(4vrcJ 66 c,S4c: Au—z.1')Cl) fc,;'Id)
�I� ��-,f� t'vlo �s'c�al�;�s)� ae�d Gns`F�,//Gt,a� 6F S'r�:�..-, �GNC.�, +c>>^ _/'✓IS'r�hiDe�
CONSTRUCTION INFORMAT)ON 't �s*" k „} � r 5
:,o ... .. � s .,...,.>.. .. -.-.-. .. _ ,r - •, ,- .s ... ....` LAS",<.n
Additional work to a er orme under this permit-c ec _appy:
HVAC 11 Gas Tank ❑Gas Piping Shutters aWindows/Doors
11 Electric El Plumbing []Sprinklers �Generator �Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 2 200 Utilities:]Sewer Septic Building Height:
01NNE�j�LESSEE '` � ; CONTRACTOR �
,,: .a . d. .w. t ¢ .�,? ' ✓ AKS .7,. <,�1: ,,.a..:` ` .It, rI., $ .-.`�.7�'` b
Name Dom, ,cd S 6c/%z, , tgnpe 6 e Ile Y, Name.'
ame A&rl .-a v:-�
Address`` :� 013-.. it/; 2711, Company:`Sr�',.:°r��r��w 'P/'L,:; /o v�
City: .Sh,'p ,Bomar;oma State: Address,;/6 SL✓. C3�,�fc// _4
Zip Code: C�.�bt96�=c.T/� "'Fax'` City: �r��� G c�c.� Stater
Phone No. /moi 73 ) 72 7-.�/.5 S Zip Code: 3�l Fax:
E-Mail: Cr•n n e .c c//e,, C9 ve, /hoo,, c'c; Phone No. 17.x.-#S 6-ari lLJ
Fill in fee simple Title Holder on next page(if different E-Mail: �,��r-• sp��fh/o�� -a,/L�. �p w+
from the Owner listed above) State or County License: C/'G%y 2 5 2$,f
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUF'3PLE11/IENTA�L,,C,0 I UCTION LIEN LAIN 1NFORMAT[O'N
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 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.
Signature of Owner essee/Contractor as Agent for Owner Signature(�fC&6rractor7License Holder
STATE OF FLO( ASTATE��/�C`_e COUNTY OF OY ® 1 �C A
RRA
COUNTY OF
Theor instru ent war,acknowledge before me The f r instru e t was ac nowledgecl before me
thisday of �G 20] by this y of 20 by
n
Name of perso aking statement Name of pers n makin statement
Personally Known OR Produced Identification Personally Known OR Produce&Identification
Type of Identification Type of Identification
PrjHWced Produced
(Signature of No (Signa _ o Notary P blic-S e f Florida)
• �iw HNSON
Commission No. : 104022030' Commission No: �al
EXPIRES:September 11,2020 '+� SARA JOHN' -
••;;od�t�•• Bonded Thou Notary PuhYC Under\.tars - �" MY COMMISSION#GG 022030
-,,4oaFtm r 11,firu Nota D Und 020
/K W
REVIEWS FRONT ZONING SUPERVISOR PLANS VE ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REV EW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17