HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED ,'1
Date: '7" "/`/ 0' Permit Number: y / Y AD
RECE11
Building.-Permit Application APR -9 2018
Planning and Development Services
'Building and code Regulation Division Permitting Depa rime t
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Resi enbtl � le County, F
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line -". Ad/�
•
•PR.QP.OSED IM•P?ROVEM:ENT,LO.CATION.. .
Address:70 5 (L P s - BOOS 4-P(^ C_'f , P-&C-L Sc'l?�->' 1 11 C- L •3 (4 q5 2
T
Legal Description:Sc�.V"1 N Q �-n l JI lfv'l ly 6:5 Z6 a
BI 1< 41 Lot- 79 � n r �J 1I6--723)
Property Tax ID#: 3 q 25' - 705 -06$Q -66 - 2— Lot No._ z9
Site Plan•Name: Block No. Ll I _
Project Name:
Setbacks FrontT Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF.WORK: t:
i-I d G djeyJ r lF r w e_r- orw st —CZA-er
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pt--s g vAr%e"o-s i W a.sCe_rbsx Cie Sf;�fS a�t rsY_t*e$,
CONSTRUCTION INFORMATION: =
Additionalworktobenerformedunder tis permit-check a appy:
❑HVAC Gas Tank .❑Gas Piping _Shutters ❑Windows/Doors
❑Electric NPlumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
oy
Cost of Construction:$_ i 46 Z Utilities: Sewer Ll Septic Building Height:
.0,11V:NER/LESSEE:. CONTRACTOR:
Name Name:
Address: '376 5 l6k4frin5 i,,- Company: e,��l c�af' �l Uri �1r5 jC
City: Po�-�- s1.H- IUB State: L Address: &Iepw-e 12jj
Zip Code:S3 q 5'7- Fax: City:44, P i Q. -r_2 State: -FL
Phone No. ct7g-7R'1--/73.7 Zip Code: 3Cil?9/ Fax:
E-Mail: Phone No. 772--5-79- 2q�2
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CSC r
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION Wi' LAW INFORMATION'-,_
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: 41
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 ncing,consult with lender or an attorney before
commencing work or recording our Notrre�&
encement.
Signature of 0 ner/Lessee/Contractor as Agegnature Contractor/License Holder "'•t
o
STATE OF FLORIZ2 STATE OF FLORIDA � c
COUNTY OF P COUNTY OF z 52 t=
The forgoing instru ent was acknowledged befo The fo oing in str ent d►as acknowledged b ge3 �
thisEday of 20�by _V� this day of D1Z[.2 20 �T
.� GL S e
Name o person making statement N me of person making statement
ersonally Known OR Produced Identification P rsona y Known OR Produced Ident
Type o t'�c tion ype of 1da1 icat'on
Produced Produced
(Signature of Not Public-State of Florida) (Signature of Wotft Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 'S EA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17