HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J /
Date: Permit Number: i �v S 3S Y
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Building Permit ApplicationPe mtun9De 10�e
Planning and Development Services t AUC/e Cough,ent
Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982 ✓/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential .
PERMIT APPLICATION FOR:
PRPPOSED I14PR®VE(UIE( T OVATION; `: r A,, 4.°. ° ...-. . .. . i :W.'". z x
Address: 1d /-79q 1 f l - ` /�.v �- ;C c-)-' _e ,3 V Y'
Leal escription: C 36 f 36` q �.-T v r ! 0 q I- qv1 �� OE
Property Tax ID tt: 2-3 059' .r3 " O(-�/ • 0062 " Lot No.
f�d��ll.d- Lot- W ut C k
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
nDr. E..Td AIL..ED-.., DP_`..C..R..I.,PT.:'.IO» N W.....:.O_..R.._K «z. -+J.. ..` ..., b..1 � .. .
a... 1x ... ��.���..T ......
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C®N�STRUCTION I'NPORMATI®N 4 i "
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
—Electric _Plumbing _Sprinklers _Generator ' Roof Pitch
Total Sq. Ft of Construction �1��,\ Sq. Ft. of First Floor:
Cost of Construction: $ I `0 Utilities: e5 wer,,, Septic;,.,.,.,_;r .uilding Height:
-OWNER/LESSEE° ,.=. CNTRACTQR: ,� ..-.tR
Name d)('t- �R U O'�tC kTe- Name r.
Addres�s::�I L,1-( ( il / (�`"j2 Company; : :..� ,•,,,„
.,..,�.: :: ..
City:c I ` 1,1,e StateV�- Address:
Zip Code:3 111 �, Fax: City: • State:
Phone No. Be)o•-a[ 0-1_ Cp7\- Zip Code: Fax:
E-Mail: )0 lel c'r` ° �1[ 5) Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
ppgry ENITALCpNSTRUCT ;Lli .LAW.IN'F®RMATIO-Ng. , J: ,. x :u
DESIGNER/ENGINEER: _Not Applicable MORTGA�c E C MPANY: ��//��_ ry t Applicable
Name: Name: (�C>> 67� ,!%�ril�
Address: Address: CCS ✓Q_ (/!j ()L
City: State: City: p rp �
State: F
Zip: Phone Zip: ,3,:1 one:
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 wor, : recordin: our Notice of Commencement.
to
. itrT4ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA + ��.�'E. STATE OF FLORIDA
COUNTY OF S COUNTY OF
The forgoing instrunmt was cknowledge�d�before me The forgoing instrument was acknowledged before me
this 0 day of 1 fX\f , 20 IX by this day of. , 20 by
Name of person making statement. Name of person making statement.
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
d ........., ...,,
..evo'''' LUCY WHEATLEY
�°�• Notaryf ubl:c `tah.efrle.ida
(Signatur of Notary Pxi•;�g of€ �o]t9GG194104 ! (Signature of Notary Public-State of Florida)
rtsiFFl.PP' My Comm.Expires Jun 29,2022 i
( 'Bonded throug i nal Notary Assn.
Commission No.� _ _ _ _ _ _ _ _ _ ,4 Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
'3ev. 8/2/17