HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' 23• ) Permit Number: / '?O OV 76J
COUNTY0..m,,`
F' L O i7. D 7Y -
Building Permit Application
Planning and Development Services MAIT 3 20f�
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
;::(0,00$ MPROVEME1'T Lf CATION _,r. .s# k
Address: .7`5- A Lo /.BA-0 P{ i Picxgrt 3Y?c1
Legal Description: L/'IZC/,)p p A A-Dn/TloA/ /U, I 6 we /j L' T6
AMC" — t5'6-9 : . 3 34-7 - Ivo)
Property Tax ID#: 1302_ - to - c033 '" 000-7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be erformed under this permit—check all- apply:
ElHVAC L1 Gas Tank riGas Piping I Shutters "WI Windows/Doors
Electric 0 Plumbing Sprinklers 111 Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 11
ctR 3 , Utilities: _Sewer ElSeptic Building Height:
CIVTRAR
Name F4)/11 -1-04.17' Name: 4DCA-A/ii)
Address:_G1& ,25- Fine CreejL QA Company: :*itS /D MD/LiF op-Tli/7- TC,
City:_ rn J -1-C State /• Address: 3 7 S. J1-W4$ i 16oY
ZipCode:_ (=L,
(�ax: City: C--`T; PCG�CL- State:
Phone No. a 31 - 3 9.$— 0 3`11 Zip Code: ' ill hlS' Fax: 'V? �s�"'l(r 3 3
E-Mail: Phone No. // a-- hO 1—'icO J
Fill in fee simple Title Holder on next page(if different E-Mail: rte.(prin g otptystuld.!►'lor'e t t LO' 1
from the Owner listed above) State or County License: CA-C- J 3 3/5-1O
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 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
commen ing work or recording your Notice of Commencement.
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Signature of Owner Lessee Contractor as Agent _<_,..::. 6 1/2 I I 1 .-- ...r.IA=
g / / g Signature of Contractor/License Holder �,.� .�:
STATE OF FLORIDA 4 P. y`' -� • 1 P4,,,ti° �
��" - STATE OF FLORIDA 1
t � �� /
COUNTY OF ii Flit' J ;p;•t COUNTY OF _o
The for oing instrument was acknowledged f. -fn z The for Ding instrument w s acknowledged before h giE z,
this day of yaU ,20( by . 2 98 9 : this9, day of p?vQ 7*" ,20/4 by 1 y q
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lit-r° `h �/C i-� n T1�k'f' 7 ".
Name of person making statement * g Name of person making statement 0
Personally Known OR Produced Identifi ;tg i' T Personally Known OR Produced Identification (11
Type of Identifical`ron , �Q • Type of Identi Ica ' a
Produced . , , k ' 1 jN Produced • V"° . .-;i C
'. lh14i'/
ii' . ,'/_r. i ��il40. 0JLf,/A .
(Signature of No .ry Public-StateofFlorid ) (Signature of No �j Public-State of Florida I ,
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