HomeMy WebLinkAboutPermit Application Perry Residence ALL APPLICABLE 1 N FO M UST BE COM PLETED APP LICATION TO BE ACCEPTED
Date : -- Permit Number:
N
Building Permit Application
Planning and Development Services
Building and Code Regulation Division f
2300 Virginia Avenue, Fort Pierce FL 34982 1/
Rhone: (772) 462-3553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR & To Select, from dropbox, dick arrow at the end of line _
gM MEE= sm
Address: , � C'. -e
Legal Description: V1
LA 62 Y,
Property .Tax I D #; Lot No.
Site Plan Name: Block No. �^
Project Name : ti t
Setbacks Front Back: Right Side: Left Side:
- -- ------- ----- ------ -- ------------
P , ''"' : 111� I
ti
�D
Add
itia I work to e er vrme un er is perm tt — c ec a app y:
HVAC _ Gas Tank Gas Piping Shutters a Windows/Door's
Electric ❑ Plumbing Sp rin klers � Generator Roof Roof pitch
Total Sq. Ft of Construction: S . fit. of First Floor:
r
Cost of Construction : $ � , tq Utilities: � Sewer -septic Building Height.
NEW
Name Name: ��►�f1 1 �S'��' C7 �,
Address:_�j � ,� � � �— ��i (J CA rc t e, CompanY:TKQf,-
0ty: C� � S C�. �`�— LL�' e-. State:Fk Address; 4 1�� SkM n� �C]y SA_
Zip Cote: Fax: City:1"�7 �-- Stake.
Phone No. 1 �t Y, Q Zip Cody : 13 Q a LA fax:
E--Mail : S- +-er-h Q15' WM Plane No. � ')' `7 `7
Fill in fee simple Tithe Holder on next page if different E-Mail : �'ruc+trnp LL- Q, f o rv-s
from the Owner listed above) State or County License.���,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
A
DESfGNER/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: N-ot Applicable
Name : Name:
Address: Address:
city: city:
Zip.: Phone : Zip: ' Phone:
OWN-E R/ CO NTRACTO R AF F I DVIT: Ap p lication is h ere by m ad e to o bta i n a perm it to do th e wo rk a nc! t nsta l lativ n as i n di cated.
{ certify that no ►rvark or installation has commenced prior to the issuance of a permit.
5t, Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
witch is in can#list with any applicable Home Owners Association rules, bylaws or and covenants that may restrict ar 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 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Budding Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full cancurrency 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 Comm encement must be recorded and posted on the jobsite
before the first inspection . If you intend to obtain financing, consult with lender or an attorney before0
.
commencIrAg work or recording Notice of Commencement,.
Sign u v w j lessee/Contractor as Agent for owner Signature of Contra /License Holder
STATE OF FLORIDA � STATE OF FLORI A
COUNTY OF .� _ v� E - -- -- COUNTY OF mac• �
The forgying instruqjent was acknowledged before me The forg ing instrujpent was acknowledged before me
"nayth of 20 by this 1�td ay of 2 by
44. )ZAO�04 104 kwpt)
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden ' ication . Type of Identification �
Produced (�ls �* e eot •fe Produced_I]r. ��'�� � 60A YO
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�gnatuCeof Note c- 5tate of Florida ) igr�ature ry Public- State of Florida j
Commission N MP
Commission No. ENDAW
40
BRENDAN SCARLETT My COMMISSION # FF960()713
' *: ,;Y` MY COMMISSION � �F9f�UQT�x . � EXl�iRES February 1 1 . 2{32Q� .
ES February '# 'f . 2{�2a -0< b3ip
��ora��so�;,•Y Rr��.: :.r.�,• ,,
REVIEWS "!2' 1913ervke.;:2&J_2FRISOR FLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17