HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR 4PPLICATION TO BE ACCEPTED
Date:
Permit Number:
.3.` Building Permit Applicata®n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-35S3 Fax: (772) 462--1.578 Commercial Residential r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: 13,_05 1VW Q002_ LUPP, C7 -
Legal Description:
Property Tax ID #1: t 1 _:2�--6a " c0 >-� (" — ox --r—, � Lot No.
Site flan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Block No.
,DETAILED DESCRIPTION OF 11 OR .-
b &z.iG(-r5 iVL v'� bQ C',r�BdUET` L1614-r11N%Gt
CONSTRUCTION INFORMATION.,
�itiona work to UGasTank
orme under tis permit-checka appy:
1]HVAC DGas PipingOGenerator
Shutters ®. Windows/Doors
lectric Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _5_0(2
S. Ft. of First Floor: _
Utilities S.
Sewer ElSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name L WT NJ 8kojAi j
Name: f #:'FLIP, ;_�M(S6LNI.,9AJ J
Address: �.q.5_3q
Company: A eLOP,4TE i L/C? C3 1 'A_ N�,� ,rdc.
City: WES —11-A E- State: 01
ZIP Cade: xf` 1 Fax:
Phone No. 1312
Address: 7173 G0110 -TI
City: Poen ST 5cleE State: FL
Zip Code: 3475 Fax:
Phone No. ?-2 - 370—� _75S
T
E -Mail:
Fill in fee simple Title Holder on next page [ if different
from the owner listed above)
E -Mail: &CURT i e e�F_(: I`RiC PSL @_ourw3i-,, CofI
State or County License: 6=030?0-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LdEN-LAW INFORMATION:
ULSIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: ^"
Aaciress:
City: State:
Zip: Phone:
BONDING COMPANY:
Name;
Address:
City:
Zip: _ Phone:
`Not Applicable
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 anc] 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 u intend to obtain financing, consul yuith lender or an attorney before
commencin ork or recor our Notice of Commencement.
Owner/
STATE OF FI
COUNTY OF
as Agent for Owner � Signage of
The forgoing instru nt was acknowledged before me
this ,� I day of 'Z iris �p20Z,5rfiy
Name of person m ng statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
Commission No. '3 714 NOq0 SEC. V�R�ti
A'��'40
REVIEWS FRONT t 19JPElA
COUNTER ea N
DATE
RECEIVED �'��i� $f/C .cTb- •c1F`..���
COMPLETED
Rev. 8/2/17
Holder
STATE OF FLORIDA
COUNTY OF '
The foFoing instr�u nent was acknowledged before me
this l d y of " 20y�ny
Name of person aking statement
Personally Known �_ OR Produced Identification
Type of identification
Produced
(Signature of Notary Publi State of F idagrz2•`.
Commission No. CC -1_3 Zja =* Seal) •.•
•
PLANS VEGETATION SEA TURTL
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