HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 115 73
COUNTY :
F L O R I D' A iP`C 1
Building Permit Application 41,0
Planning and Development Services 1
Building and Code Regulation Division •4a.06,A
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 4"4417 ,
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION: ,
Address: Via 9 Id . L.6. , {-. 4 \ . �'(�-1 (2 34"q�F/ 7 . . .
Legal Description: 07'•
oc f r,1/41 i4-00,p-d5 t I IL i LOTS (p c2,4 `7
L O.2 Ip. i ) L 0e /O` / - 21 3 ):
Property Tax ID#: - - — Lot No. (p 4.17
P Y ��D(� 5oa �� �� 7
Site Plan Name: Block No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK (I_.0)
. „-jeJ-r) uue 1 124_17/ace_ LD 1 i,-)0bL 66 'rnp - _ rod.uc
CONSTRUCTION INFORMATION. : ' "' •°` ,
Additional work to be erformed under this permit—check all- apply:
HVAC Gas Tank nGas Piping Shutters 0 Windows/Doors
0Electric 0 Plumbing Sprinklers 0 Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Ay Cost of Construction:$ /I5 •--- Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE. . CONTRACTOR:
Name (arri Q4' -Tor‘..1... e.))--? Name:�G�y-to hi ii ll rJ 4-].1---6"c l'
c )
Address: \C 3 NJ. 4`- - Company: : 3 t Eho , XMC -
City: — - • /i�P reR- State:R Address: Z• _' rP. */l -
Zip Code: ti•Ct Cr/ Fax: City: State:
Phone No. Zip Code: , a_ Fax:
E-Mail: Phone No. --7-7, .. 7 3 06,(96 1
Fill in fee simple Title Holder on next page(if different E-Mail: I of "J) ! -F=e I-i QT j.6evol
from the Owner listed above) State or County License: (j A:woQ 6q-.7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUGTfON LIEN LAW INE.0alVMA1ION
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: I
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.
c / i /
A i a /'
Signature •f Owner/Less--/Contractor as Agent for Owner Signature of C•ntractor/Lice e Holder
STATE OF FLORIDA r , . I STATE OF FLORIDA('/ / C�
COUNTY OF IJ4I -( COUNTY OF J-Tle
The forgoing instrument/� was acknowledged efore me The forgoing instru ent was acknowledgeopefore me
this_=day of I 'i Ci,Y ,20 Irby this day of 6nG w ,20L by
(Tererm tft !( �J1��Jcvr m,;w'k (c (Xii(VU,"
Name of perso making statement Name of person making statement
Personally Known (X OR Produced Identification Personally Known 'YL OR Produced Identification
Type • •: tification Type of Identification
Pro.uced Prod
i - I
j Sr'''! eelmipto
. ' : '
(Signatu :A, _ P '. ;n `t'1,:f:�:. ) • (Sign., .- • � .ubli@taIil�loolattvlda
of n' Expires 08/16/2020 • 4%, a Joshua Shane Atberico
My Commission GO 02Q�
COmmiSSi• ` \•. Commission ? 0:1'o,r Exolres08/16/2020 Peal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17