HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: L� �i! Permit Number: ��d 1'6U-`�1
I ;. .. RECEIVED
Building Permit Application APR 1 20,E
Planning and Development Services
Building and Code Regulation Division ST. WON QgiwnE p@rmiting
2300 Virginia Avenue, Fort Pierce FL 34982 - - -
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y—
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S�J C�
PROPOSED IMPROVEMENT LOCATION:
Address: - C_7 7� Js-,J'o h Tc✓ /
Legal Description: p�cs nc�c.� �a a a� 9ce4�^f 4`V, G. t•�r�y• 9-?) •'� J3-�`�.9�-f'�
Property Tax lD#:J V IS-- 7D b -0 C7 - 3 Lot No. /3
Site Plan Name: Block No.
Project Name: ws ;"1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
of
[CONSTRUCTION INFORMATION:
Additional work to be oerformed under t ispermit-check a HVAC Gas Tank E]Gas Piping _r�apply:
Shutters ❑Windows/Doors
❑Electric ❑ Plumbing Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
6'Cost of Construction:$ � 74 6 Utilities:0Sewer ESeptic Building Height:2-r-30
OWNER/LESSEE: COfT€ CTQRz
Name Ao in Name: J l
Address: 79 re-- Company: Lo cc/ -if- d
City: f 6'/ J C(,C r r State:rtl Address: J )
Zip Code: J4� / e,!� Fax: /-141 City:��'r 4�,C/L.G State: Ftl
Phone No. 31 7- 7 1- 09.f -t Zip Code: L7 'V'� Y< Fax: 772-y61-6�J�f"
E-Mail: JAZ/47 Phone No. 772-5��_ A/4-
Fill
72-
Fill in fee simple Title Holder on next page (if different E-Mail: TO!'►') X 's e v , Ga{.nA�►
from the Owner listed above) State or County License:,SCG 1211,5 1,f-o
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _)L 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: XNot 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.
gnature of Owner/ se Contractor as Agent for Owner --5ignatLrre of Contrac or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k - t- y� �� COUNTY OF � , L\-�-\-'�
The for oing instrument was acknowledged before me The forgoing instrument was acknowledge before me
this day of q i? ` 20 by this�'` day of q C t ,20 t 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
Produced 10 L- Produced L >D
(Signature of Notary Pu lic-State of Florida) (Signature of NotaryPublic-State of,Fl ridd)
p,�p23
023
Commission No. V ��o\ (Seal) s:.2o2�ie�• Commission No. £d _.'iG�SrI)
.-Aenyr -
- Bo,dcd Thru Notary DebieUndarwriio `
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17