HomeMy WebLinkAboutBuilding Permit Application (3) ALL APPLICA
3D3 LE 7,7 BE COMPLETED FOR APPLICATION TO BE ACCEPTED OY
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Date: ' Permit Number:
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Building Permit Application Permian
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Planning and Development Services fit.Lug a CQ ty ent
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 IMPROVEMENT LOCATION: ( '
Address: nOS I P \fl C \1C (he Or, R)� —3U— UC_ c 3LA.0 -p
Legal Description: trYSCX � V(in+-64-1(y) e ri— ) 1 ' c -\o- ��` I C K 33/
'Ss) (or 1Wn- .'a)
Property Tax ID#: 3,-.7_ ,1 Rb 5 l '3( .) Lot No. '"1
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
R-er0&-e.e ,7,b o cz),-,p P.-.[..t z— r c e r (,.rn 4_.,cv
FPI_ 5 i-,L &01/4.01P\ ��o c r�-,J:lnr s re� IPe r\-JCA - 4-d
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CONSTRUCTION
—CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit-check all pull apply:
IHV Gas Tank ❑Gas Piping I _Shutters Q Windows/Doors
Electric ❑ Plumbing nS Sprinklers Generator Roof Roof pitch
— g LJ p 0
Total Sq. Ft of Construction: S . Ft.of First Floor:
OC.) ✓-
Cost of Construction: $ i Utilities: I Sewer 111Septic Building Height:
OWNER/LEGE Cj-r) CONTRACTOR:
Name 1 ..Q`1--}-i owe_Lt2 . C. Name: tr , i.1 Tl a>.i Cin
Address: S I �IQIPOhOn \ (Ic.E Company: Cf� �r 1 d • c-i-f i�
city:R;(-1-- S1-. I` State: _'Address: 4-
CH i') 1 \ o
Zip Code:34 gLP Fax:11a 14` a—City: 42b(1 Lg t �ax�1aP((if State:'{
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Phone No17 - 4 ^ _0.40-� Zip Code:34 (�- � -3�
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E-Mai +f19're NMRU.CC c h. PhoneNo.T1a-eiid -)a
Fill in fee simple Title Holder on next page(if different E-Mai ).QY1t4%f2Cr.._QfI xo' i 'cKD 9 ma IT .co
from the Owner listed above) State or County License:FL) 3O0(o2i9
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
commencin: work or -cor.-: our Notice of Commencement.
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Signatur hof 0 ne Lessee ontractor as Agent for Owner Signature of Co ac r/License Holder
STATE OF FLORID j I0 1."- STATE OF FL�1A Ludj_c_iCOUNTY OF ( 't— I--u``/ COUNTY OF , ��
The f r i ir' tru�en,��ledge):1 fore me The stru en ash. a ledg 1.: ire me
thi ` [day of V". 20 ( by thi day of ►1�:•� 20 I `.y
( SCI ► l C urr oiie I ftoxyvcun
Name of per. making statement Name o rson making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id 'fitorn� ( LiD� I Type of Idenfc�'�on� 11—A-0 Produced Produged
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11 ( Q ' i
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(S.:i iture of Notary 'ublic-State of Florida) (Si:na' re of Notary Pu• ic-State of F orida)
OlkullCommission No. �0 ..ERIICp'ii, (Seal) Commission No. ,oiiiiiii, (Seal)
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:Z NOTARY �': **)..r. ? io.O
REVIEWS = FR BB"1� ZONING SUPERVISOR PLANS V)~GETATI -I 1 AR.S£4,T6R3LE MANGROVE
CK�1N ER �EVIEfiN REVIEW REVIEW EVIEWPUBL c REVIEW REVIEW
DATE �-;;;9,9 n?#GG AS�'\a,'. '' • J1�a) 1�
RECEIVED ''ii�TFOFFirO...... %yi.••:i'GG 6g•'•p���`
DATE ''�/Hu I I I A IH,\` ii���F OF F i (a�����`
COMPLETED 11/,,lmii n��`�
Rev.8/2/17
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