HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5p/ 20/g Permit Number:
COUNTY , !"4,>:
Building Permit Application IV
OPlanning and Development Services 1 q
Building and Code Regulation Division periyl�,n ?08
2300 Virginia Avenue,Fort Pierce FL 34982 &' �„j'oepe
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ��co4o ent
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT YX.LOCATION:
Address: I 12,E 5 ` .,L cI,ttL-A - VQ( 17nJt
Legal Description:`k e(YlOr(2. 4- Q Gi< ro 4-ec oat, iii
Property Tax ID#: J4501:1- 120 - DOD l-' ODD/,A Lot No.
Site Plan Name: Block No.
Project Name: II
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
. 'PAW 44 Ni(Itte "Mei bdi -fir bok .
)wj NsJ1.
CONSTRUCTION INFORMATION: (
Additional work to be ertormed under this permit-check all apply:
HVAC [1 Gas Tank Gas Piping Shutters 0 Windows/Doors
ilElectric 0 Plumbing ❑Sprinklers DGenerator i i Roof Roof pitch
Total Sq. Ft of Construction: S FtFt.of First Floor:-
Cost of Construction:$ I p 00 .o° Utilities: I Sewer IIISepticBuilding Height:
OWNER/LESSEE: CONTRACTOR:
Name_Pin(Y1 (Gt �k-��� Name: , " , ' ( .
Address: IN25 5'Turku i(hd t i i/1'll)-t- Company: . , 'o'er (. 1� CMN . 1 i 214, . (
City: eiPAUS(.lh 9GlC104- State: (,. Address:ii .paa-ter Ate - -4-c)( i
Zip Cock. tl6/S-1 Fax: City: r 4. State rt
Phone No.-44-0 3S — ()CQC1 Zip Code: %)`,(,:1gt) Fax:
E-Mail: Phone No. -Y2) , ID, 9c441- I1
Fill in fee simple Title Holder on next page(if different E-Mail: I V4LQ� Cal 14 .I cam 11
from the Owner listed above) State or County License: 5-1Z1 P —,gccT;,t,15Q-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5
• 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:
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 your Notice of Commencement.
(AAL
Signature of Owner/Lessee/Cor as Agent for Owner Signature of ontracto "cense Holder
STATE OF FLORIDA S' Fitt STATE OF FLORIDA c- ,
COUNTY OF COUNTY OF
The for ping instru nt was acknowledged efore me The fob oing instru nt was acknowiedgecbefore me'
this,..\/d y of ,20_IIby this I I day of 201 by
\ ger
t--W1(.4./.4 ?..bt>11(- 9 2.-U CM2---
Name of#ers aking statement Name of perso making statement
Personally Known )(, OR Produced Identification Personally Known k OR Produced Identification
Type of Identification ' Type of Identification
roduced roduced I
\/ A An . -/V v I C14--(22-(-4
(Si not-.4.
re of N try Public-Skate of Florida) (Sig a re of N•a.ry PubliciState of Florida)U
'"" Corn fission No. ""'"'� s€13I[111FER M.CONLEy
Corn • ion No. 4 2o��SEgs11FERM( EY '�'
IMYCOM S1SSlONh�l�o22 MYCOIMMISSION#GG179123
Marc ?�„ EXPIRES;N1azch 23,202
> d EXPIRE,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED '
DATE
COMPLETED
Rev.8/2/17