HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LEI TIVWY
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �--.' a 1 Permit Number: 3D3 ''. " J
CO UR. INTYo sa-
MAR9.TDB
Building Permit Application Permittin
Planning and Development Services St,-Lic a Cr�9 Dep.
ty ent
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential __
,Y)_____
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION::. cj(
Address: OS 1 P rratk Cahes Or, �, n�-*- U( Ao / 3LA A Lp_
Legal Description: f Com.., 2 VI. N . , —_a i t 1 A--1� ( Iii �3
3--s) cc, 1y - .' )
Property Tax ID#: 3701 li bj- j(ib(1 _? Lot No. 3`1
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'R-e_ l[re e ®Zv o A-,--,p z ('c�,e r' Eolzpl t/
FILL 5L.LJ - &c,c,oyN Yea- ._(-.-,..,, ,,,,, s n-ee.. ,- Per.-.Ic- a_o • -d
e`x%51-: el Cry-,-tf.� 6o r P.,et'wx --
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all that apply:
PTC Gas Tank Gas Piping _Shutters U Windows/Doors
Electric ❑ Plumbing S rinklers Generator n Roof pitch p I I Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ tic,‘-', OC) �~ Utilities: l 'Sewer III Septic Building Height:
OWNER/LL E : 0Jfl CONTRACTOR: r,
NameO f\ -Q`I---t eL . Name: t-(�` , ice,1 - C rr OI\
Address: (-- I 1QI� �On If!�S Company:t4 )er l _� 1�C--hr1�
City:��"E S • 1 State: ,Address: 4.r- ^I.�GJ )(� r- I voi
Zip Code:31 Fax:11a-3I ` a--City: AD(.6- itC)(C-P
State: L,
Phone No.--17 L4 — \I _SAO Zip Code:3 rax�lar(�-�01Q�-/�
E-MaiPe+I 19(9 N\1 RLC..Com Phone No.`11a--4424-1C7Q� ,
Fill in fee simple TitlevTiHolder on next page(if different E-Mail.QY),ktiPer..iarver91) fOf� 5 ma 1 ,L0
from the Owner listed above) State or County License:ELI 3OO(oa� 9
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: _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 -cor.--g your Notice of Commencement.
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hof 0 ne Lessee ontractor as Agent for Owner Signature of Co ac r/License Holder
STATE OF FLORI /� STATE OF FL A WaCOUNTY OF � � f--�``/L COUNTY OF 1�
The f r tru e y� s ledgep fore me The stru en ash. ,• ledg 11- •re me
thi�'1da'y of `A ,20 I by thi day of u it A 20 I ty
I ah ea I if 1 aVrkaft- ,
fl a-Xrill On
Name of pe7n making statement Name otpyrson making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id i C�a �,_ j I \ „� n �/� Type of Identificap'f�n
Produced �( � I V (���V I Produ ed Yc.���� �
< `
LI i \ I
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(S.:ii iture of Notary 'ublic-State of Florida ) (Si:nature of Notary Pu• ic-State of F orida)
Commission No. `\" ERIICO,//i,, (Seal) Commission No. `� iiiilurrr, (Seal)
...Mlssiody'•!16) <-, ��`\\‘`\F ER
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REVIEWS _ FR(. ,IBB•� ZQNINt SUPERVISOR PLANS V+±GE ' TI141 14ftEtCURILE MANGROVE
CN ETC ��EVIEIV REVIEW REVIEW EVIEWpU8 REVIEW REVIEW
DATE ','>'••M#GG15.•QQ � cn ,� ;.
RECEIVED
. DATE VED i��iq/FOF"iirriiIF}•
u',0\\� //hO' ���OF FLOR��P�\\``
COMPLETED �irrrn A l i i I1‘��`�
Rev.8/2/17