HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 0
KECEZVEID
Building Permit Applicat on APR 17
Planning and Development Services 2018
Building and Code Regulation Division Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 a rtm e n t
Phone:(772)462-1553 Fax: (772)462-1578 Commercial "R't6SideQllihfl L
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:__I U 3 Y,60-h �_1PieY� ► 3il qq �_d+ i
r
Legal Description: �Csc�f\�'Cla l'�r()�, IIY1F�b,�e f amc f A,ry
Property Tax ID#: , D V — l7 Lot No.
Site Plan Name: Cc ,An1 dry CoUe- ,1.e_ borry, R FK Block No.
Project Name:
Setbacks Front Right Side: 1,r) LeftSide:
DETAILED DESCRIPTION,OF WORK:
Ycb b I (-2 cyne
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC f Gas Tank ❑Gas PipingnGenerator
Shutters Q Windows/Doors
0 Electric ElPlumbing Sprinklers g Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor: J(7 ?La,
Cost of Construction:$ Utilities:In Sewer ElSeptic Building Height:
OWNERAESSEE: ����n C�( CONTRACTOR: �y C `l
Name aate,Mn, CDS b. a Name: Sbko 'fk�e_ , I1A\
Address: U,5— Company: 64ai &(--, INC-
City:
NGCity: KJ -r'ce, State:EL Address:�•a l��X �
Zi Code: 3
p ���� Fax: City: faaP_ 10.ke. Stater
Phone No. Zip Code: --L_2)R3� Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:I/1_i\l-Ew�s q�(1G .CD/Yl
from the Owner listed above) State or County License: 0,S-61 Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
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 recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF p c)l K COUNTY OF
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ry,\cknG� 201$ by this IL day of I' ct[f, 20—LR by
S�ai n r\ �rn
Name of person making statement Name of person making statement
Personally Known�< OR Produced Identification Personally Known X _OR Produced Identification
Type of Identification Type of Identification
Produced_T21�O/ c �fY)t�l� Produced W
(Signature e „ (Si nature of Notary Pub c- ate of Flo a)
ZZ0Z14 tlE0 6811
Commission o. tetLst E)0uoJssiwwo�Rw 901 1 Commission No. (Seal)
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eppol�10 etels OHM ti9 AO
REVIEWS FRONT ZONING SUPERVISOR PLANSFER%Q\E4aAWTiQD!'u_o_is-
11E$EAic$c�31R �'O ANGROVE
COUNTER REVIEW REVIEW REVIEW PnR EVIEW
DATE
RECEIVED epuo1_q;o e3eiS° N
Ind tieso
DATE
COMPLETED
Rev.8/2/17