HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ts
�Date: / Permit Number: - 0orC�n
- e RFC�IV�D
Building Permit Application RAY 0,0 20,
'Planning and DeveloprrientServices permlrtlpsr y o
Building and Code Regulation Division Lupe fou„ty ent
2300 Virginia Avenue,Fort Pierce FL 34982
j Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -J b� �C)ber�S Q� Sod E, @,f C._ D_ ., 3 LI q 5 i
Legal Description: Layevooc)d PbAv- - Un�� 02- GLS
Property Tax ID#:` /I 3 P 1- (9 OZ' d 1 1 ' ��� —(o Lot No. (-
Site Plan Name: V b Block No. IJP
Project Name: y0 1$A,
Setbacks Front Back: Right Side: Left Side:
,DETAILED .DESCRIPTION OF WORK:
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f (Zerr•ov�. p 1e, roo'F 'Sy s'rrrY. o,►�cl i I)sem,I I
G s P ha I f S)l i r�l e. .ro0 F S ys }0h'1 .
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all appy:
11HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing F]Sprinklers FIGenerator Roof S�12 Roof pitch
,Total Sq. Ft of Construction: 2 H 83 S .Ft.of First Floor:
Cost of Construction:$ Utilities:�Sewer Septic Building Height: r�
'OWNER/LESSEE: ,CONTRACTOR. ”
Name Aon VoIsO- Name: (zobert em, J r
Address: —1 LA O(o 'zobex�5 26, Company: D11100 200E i 1N�
City: P i erC F. State: �L Address: 1 c1S0 SE Grt„oe la►,cl A��e
I
Zip Code: 3 L-I°151 Fax: City: P,-r4 Si• Lucke State: FL_
Phone No. _718 — &19-6010 Zip Code: 59C,15Z- Fax:
E-Mail: Phone No. --7-7Z - -713- 72K0
Fill-in fee simple Title Holder on next page(if different E-Mail: D i I Ior,PoaF�rc,l 1 L o��10°I� •Cr)i�
from the Owner listed above) State or County License: CCC, t33 I',W b
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONS��RUCTION LIEN LAW INFORMATtO,N �' � t
a fi.
5
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.
Sig ature of Owne essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF _QAiyC.e.e_ COUNTY OF yUC.t.4__?
,
The forg ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �'YY��'�(�20 18 by this day of 2M 201 by
Name of p rson making statement Name of prson making statement
nown
Personally Known OR Produced Identification Personally KOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign (Signat
SALLY MEISNER +" SALLY M
Com State of Florida-Notary Commi EISNER
�`�sYP, (f;State of Florida-Notary P&
, �
'_. ommis GG 1925 a GG 192
My Marchcommission
2022 fres �r My Commission Expiros
` +u"� ` March 06, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17