HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
/ c� r o-2, -511Date: '' / � )f I (a Permit Number:
COUNTY
F :c o R- I D. A -
Building Permit Application �` ®
Planning and Development Services APR 1"0 20'0
Building and Code Regulation Division Permitting pe ent
2300 Virginia Avenue,Fort Pierce FL 34982 K
tLucie partmPhone: (772)462-1553 Fax: (772).462-1578 Commercial Residential County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ?. 9-0), 1 I"aC- 'Gig
Legal Description:
Property Tax ID#: 1 4 3-2 — q. 0 S — _0 B S � G°° _ 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Re40)tat VV.) J l 5-0 A r)11,14A / on,614---, (--,A„,ec:-- 4... 1,...)4f.t,
4-14.--peitdot
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s vppLi_t. Msh t 1 h 5 ro , .5.1/ .
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all ha apply:
HVAC II Gas Tank nGas Piping I 'Shutters❑ Windows/Doors ,
ITIElectric 0 Plumbing ❑Sprinklers IIIGenerator ElRoofRoof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 1 AS-0,0 2 Utilities: Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Dd-i,S`I Terre Name: \(`ic L '1 '
Address: '2.9 o 3 -1 r d P l C U 1 if Company: W i r 0.04- Z r(1 L
City: a(w- 'R(epee State: r1.- Address: 3 S o Li F6(\+0.A etc` (t.v'
Zip Code: 3 c(i r"1 C Fax: City: r O N- ' .(\Le State: l_'
-7
Phone No. 1 7 2` 9'I O— 3 9.(1-0 Zip Code: 36-'t'4'ci 7 Fax:
E-Mail: Phone No. 'i 72 l 'S 0 SCY°
Fill in fee simple Title Holder on next page(if different E-Mail: 'V' ( ek1-4-7 Vice U..0 I . COM
from the Owner listed above) State or County License: Z G G 6 SS ( 7 ,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
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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. 1
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 reco ding your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Liclnse Holder .
STATE OF FLORIDA S-1---Luc&z___ STATE OF FLORIDA i
COUNTY OFCOUNTY OF 31 ` U..,,-(-___( e
The forgoing instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
this I'D day of ci k ,20 lis by this I O day of r ‘ 1 ,20 S---by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification .
"iced "c—C.1 0 Produc d 'Ft-
1,1 44 Ctli) ' r
( igna ;of NoPc Stof Flora Notary ) ry y )
Commission No. "�'.'�'. (Seal�` Commission No. (Seal)
)1.;� ,,, /t�,�t,+HNA INGRAM
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*'r;�- Notan, Public-State of Florida
l ° .i Amy Comm.
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:.* c P. Aires Dec 20 2018
=;�-'� `a: %ummissn •n #F
i? FO}F4' FF 177 43
REVIEWS FRONT• ZONINGr_� ' 'SUPERVjSQR s' PLANS VEGETATI `�: RTLg;1S f ',. ^•4_ l
COUNTER REVIEW REVIEW":" REVIEW REVIEW i�liriu� rya°acs,:c7...''
lorida
DATE ,..ta-P..
�o roao Do E.pins Dec .:Arida;`��
RECEIVED Be , mmissi��n#F 20.2018 d?'
DATE Vational
COMPLETED ^y--,,,_.:.=_-.. NotuYAgn. '
Rev.8/2/17