HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN F9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: /lJ � 1U�3 Permit Number:
• LA
EIVED
Building Permit Application 0 2018Planning and Development ServicesBuilding and Code Regulation Division nty p�rn11tt1
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: Gr-cenbri --e- Cit-Cle PC),-t- 5�- LV-Cic , �(, ;L(c (n
Legal Description: Poi I q PUD I
�r34�-5 C.D+ E31 ( o+2 1Le74- i9 7
Property Tax ID#: 33 oZQ - _700^ L"�(DE>cpyoCj Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
L. ce �02 L ILL
EIS,-iG t fat Pump
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit-check a appy:
HVAC n Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric ®Plumbing E]Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �i Utilities:CnSewerSeptic Building Height:
OWN�ER�AESSEE: CONTRACTOR:
Name QU9aO - rYY.�rt4 UOhar-2 Name: 7 Se (-)C�'& IVc _
Address: —774) lr'ot Company: DoslIUC;S GbDI q�r✓Lcc 1 &
City: 't L 1.t Ci State: FL- Address: 270�1 C:)�C_ &[[Cy rDn V t°
Zip Code: 2 QBE& Fax: ni CA_ City: mart ill erCe State: 12
Phone No. -1`7 2- ?)- :; S(,,(D Zip Code: `3Lq&) Fax:-7-?Z.- abl-SWc
E-Mail: Phone No. 1 J 7- -2-7; -,S 620r1
Fill in fee simple Title Holder on next page(if different E-Mail: rnICV)ete__(_.Q Ko-7 3 C- �[Ctt--\oD, (Orn
from the Owner listed above) State or County License:Com. i L6 qoj_�
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 thepermit 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.
i natur of Owner/Lessee/Contractor as Agent for Owner Signaugev Contractor/License Holder
STAT FLO DA STATE O ORI A \
COUNTY OF �T_ G��tiy COUNTY OF �T
The forggjng instrumeffl
was acknowledged before me TheMr%ng instru t was acknowledged before me
this1(Q dayof by thisday of0�by
OS v� 6�1 61�1
Name of person making statement / ---game of person making statement /
Personally Known OR Produced Identificationy Personally Known OR Produced Identification
Type of Iden i a ' Type of Ideltifiration
Produced 1— Produced
1
14 AM-0 L-t A/.\-k
(Signatof Publi - rida Si a of Notary u ' to ' �t,W
ELEN P.SS Esu. DO f}�p$, tyQtary Public,State of F
Commission No, ,� � �� a '("... fission No. d"S .. a s;a,t�965 4
otary Pub!, State of or da
r'V�,), iinnfi FF 965 5 My comm.e�ires Feb
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t" s Feb.2 2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17