HomeMy WebLinkAboutBuilding Permit ApplicationTALLAPPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
ate: .3 ( 7 Permit Number: 1 O )- 0 l(/0�o� !. -6J RECEIVED
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Building Permit Application MAR 0 7 2018
Planning and Development Services ST. Lyth�o
Building and Code Regulation Division �lf7tY� PArmitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: lot/1., Crosby I E1-
Legal Description: POD Z6 d+ lie. Qe Serie- Q(^4.sr g C pt�S Pent Lt d
r
Property Tax ID It:332-7 9 0 ry dC)2-6 OOo 3 Lot No. 6 5-
Site
Site Plan Name: Part-:,s I-. 9-e-Si'd-Gwc-C. Block No.
Project Name: Ptnlrr',6L PS,' Lt
Setbacks Front Back: Right Side:_ _ Left Side:
DETAILED DESCRIPTION OF WORK:
i .e.-
eyv -R r 5 ' Ze___
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit-check all-Jial apply:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
ElElectric 0Plumbing Sprinklers 0 Generator _Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Z3 0a ----- Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Namesar.�s $ Ur i -Pa,rrr�s Name: £ ,r+15 I ac.i..4 PA
Address:/011 L (..,...,47 pt- Company: . 6k.): (i-er5 C.or j -
City: ?or+ Sr Gvc-'? State: F6- Address: 3L3 I 5 t bor)+.,'..,'c.4 Ye.-rt`
Zip Code:3 Ll 9 g‘ Fax: City: $1vei./4- State:F4-
Phone No' Z_ 7 $( _ $'31/ Zip Code: 3t/cif'7 Fax:
E-Mail: Phone No. )9 Z 2?I Z.5-05-
Fill in fee simple Title Holder on next page(if different E-Mail: f<ta r bu. I uS . co-P1
from the Owner listed above) State or County License: <c. 2.3 $63
�L IsoT7'19
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: o' 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PI A.iIl 0 COUNTY OF II,Gt, -,Y1
The for oing instru ent was acknowledged before me The forming instrument was acknowledgeOpefore me
this day of Gt. 20/?by this 7' day of -Jaji j t.a.-si - ,20/Y by
C.-Jr-fir S "1`J
Name of person king statement Name of person making statement
Personally Known • OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod d Produc
(Signature of Notary Public-State of londa) ignature of Notary Public-State of Florid )
�k-/3 93 NOTARY M. &M". FFl3/ '3b ANAwNA M. I E
Commission No. � � �� i' '•< NOTARY PUB o fission No. (S +••• -.,: ;,;:_)rARY PU3LlC
•-STATE OF FL IDA f STA r E OF F ARIDA
•�+:' ' Damn#FF131 '•vela! rnmr
— Expires 6/11/2018 / ie: FFh3rL8�36
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVEires6,1 '2018
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE
COMPLETED
Rev.8/2/17