HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR:APPLICATION TO BE ACCEPTED �q
Date: til I a Permit Number:_I 014 -�� r
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:-(772)4624553 Fax:(772)462-1578 Commercial Residential. X,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED 1MPR0IJEMENT�OCATIOIVf 3 ,$
Address: q OS L aKc si d-t Fft+ P,tree , FL• 3 9st
Legal Description: I.g4WOo �e4rK -'Lln:f �► - SLK ZI I.0+ 15_4m4a i3 tiff'.
fL -140 — Z311 : 7SoS — 17S�
Property.Tax ID#: 130 ' 1y6 d I y 1 _6W-4& Lot-No. 25'
Site Plan-Name: Block No. 2
Project Name: 4AntPj*_jC
Setbacks Front Back: Right Side:. Left Side:
.1 .: .. _ F...YF- .. x.A`4 - fi Y - k - "Y F.*•e' S Y s? LY f,
DETAILED DESCIIpT{ON OUORK is ,3 t �� <�
14?1%, ?-o4k Oft-VW Vis. F;ww sK t-f pput Va?or Pope. b4cod Lo.ire
1a4AF%t, . AFjpkr !WucAL.0 -f 64v in 2 c4ft S and 4txjuj't� Ori eX+4,tw
CONSTRIJYCTIONINFORMATI'ON
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Additional work to Ppprtormed under this permit-c ec a appy: T
®HVAC r Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑Plumbing QSprinklers F Generator Roof Roof pitch
Total Sq..Ft of Construction: InIO-0. Sq. Ft.of First Floor:
Cost of Construction:$ 70 x.00.00 Utilities: Sewer❑'Septic Building Height:
i OWNER LESSEE ` t' j'CONTRACTOR
Name M Name:�A!gn aei4Cat _
Address �T.�® tayowe Company: 61'1Act.Ja-l-a,r ni 5i�7 .S 1 C
City:r k :P.o`cG . State.: Address:
$14 S*C10 V"%
Zip Code: 3 951 Fax: City: fir Qi�C>e State:EL,,_
Phone No: 7'?— Z01- 1161 161 Zip Code: 34_Ct41Fax: 772 -kG6 46W.
E-Mail:- Phone No. *71'Z %0 9K4SI
Fill in fee simp a Title Holder on next page(if different f-Mail: b>!�$Wa //- c�i511W 11 G 040AW1„
from the Owner listed above) State or County License: Za3 CIO Goin
if;;al�we cf can§tr:ct on is x,2500 of more,a RECORDED Notice of C-o—mmericement-i required.
77
SUl?PLENIENTAL CQNSTRUCTION LIEN LAIN INF�Z}R!!/IATIQN5 3'
DESIGNER/ENGINEER: Not Applicable MORTGAGE~COMPANY:' _)�L Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
-FEE SIMPLE TITLE HQLDER: Not Applicable BONDING COMPANY: Not Applicable
,Name: G41- AA �,eor Name:
tAddress:7ga Le[Ktc,:dG %/hu_ Address:
1City: aw-le 1p Q cu City:
Zip: :SQq 5I Phone: 777.—265—'77G 5 _ 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,orand 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.
Inconsideration of the graniing of this requested permit,I do hereby agree that l 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 concurrencyreview: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.
r�
5ignature-of O ner/Lessee/Contractor as gent for Owner Signatur of Contractor/License Holder .
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF' COUNTY OF S-'. Lucie
The forgoing instrurrient was acknowledged before me The for oing instrument was acknowledged before me
this `�-` yof ��r�� .24 ,.by this dayof�pri .20by
Na statement Name of person making statement
Per y Known OR Produ Identification \_ZZ Personally Known _OR-Produced Identification
pe of Identification Type of Identification
Pro ce Lfl L �- . SLS2 '�aQ �� Produced
(Signature of Notaryu - (Signature of N ry ublic-State of Florida)
Commission No.: a�ILPI (Seal) Commission No.�Str�.`I'�Z� . t CHARIWLYN JOHNSON
4YPUBLIC
'STATEMTLORIDA
1 Contift#GG149"
�► . 11 es lurir&UWT�_
;REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE- ` 'MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
2�
'. . ,'t Nary LJ