HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�1Date: `f / 7 /z( / 5( Permit Number: i'61D5- 0&'30
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Building Permit Application kit® 0
Planning and Development Services p@ j 17 ph.
Building and Code Regulation Division Re.i��A�,�g�
2300 Virginia Avenue,Fort Pierce FL 34982 C',����?!qfr n!
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: I c3.11 /3a/ I/a(hor Pr.
Legal Description: 1 i 3 J Oar F/arbo. .(/rrve. - CSG Iden pangs --MOb; I c ho pet co
Property Tax ID#: 3O�J• a) I ' 0 QHS• 0005- Lot No.
Site Plan Name: ODI--00 11 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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it of, OFF cX,S4'in5 QooF down ,J
{-0 loll (cplp�cc fol-Icd dor,,�ooG) ol5 he.cded
(Zc -VIo�iI re3GGL . - a coac1 %ns,iall Scif—gd/1ereel ande-rlayr.,,c,v-P .•`hd-I'a ► )
arclltiLcckval SA ncle, 40 c_ o&c
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CONSTRUCTION INFORMATION
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Additional work to be performed under this permit—check all;hat apply:
HVAC _Gas Tank riGas Piping n
nI Shutters ❑Windows/Doors.
I I Electric ❑ Plumbing 11 Sprinklers I I Generator -Roof H 112.1 Roof pitch
Total Sq. Ft of Construction: /60 S Ft.of First Floor: gg61
Cost of Construction:$ 44-40() Utilities: AO Sewer _Septic Building Height:
OWNER/LESSEE Ery CONTRACTOR r R ` '
Name Sr,$an Chris E-j Sc,. Name: (L i c IN Aft) (0 11 c{'-1
Address: / Fi3 / liar dar,40, Pr Company: 1.-cot, BustCrs Tejo` aepci..rr
City: For{ Pi crc.f State: FL. Address: G 101 Bvc.han l,i Jr I
Zip Code: Fax: City: F6 rd / crc.c. State: FL.
Phone No. -.'3..`L_QUI- 522`2_ Zip Code: 3il'n Fax:
E-Mail: Phone No. ( `77 Z 3 3 2 —8`k5
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Fill in fee simple Title Holder on next page(if different E-Mail: P;Gii;c colt c-E-I'r' gmu i 1 . cow,
from the Owner listed above) State or County License: CCL 1330 a 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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:
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 your Notice of Commencement.
Aci(N0A,.A V , 0/73. (0. -;___ A:dootA4-4 r (10Mire _)- s
Signature of Owner/Lessee/Contractor as Agent or Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA I
COUNTY OF S r\k L_6 e COUNTY OF ,u(. .A- Lcie-
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this H day of inel(;<<( , 20 a by this.day of nele,'.tt(
,20 1 ./ by
\Cwt CAhrt.V C\ V V . COU'eA 24.0 i([l \1• Co 1 t-e
(Name of person acknowledging) (Name of person acknowledging)
I 0 (A)LbN 9Criii-e
(Signature o otary P lic-State of Florida) (Signatu of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
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Commission No. S-a, •��:•mmission No. 1. 1. r-,----:::'.%—
r......_ ..,,
, SALLY FORTES o;.•�4°; , SL Y FORTES M
.���°%'•- _. „ . 47625 �;+�a.i= Commission N GG 47625
*�r '_ mission Expires ;,„rii .,S
Revised 07/15/2014 "�;, ?'s; My Com . 4, 00-x. November 15, 2020
November 15, 2020 ,�„���
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS