HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ( v�
CQ J.INT ®�,q
FL 0 R 1 UAL -"' Ati r�
- Building Permit ApplicationO 92078
Planning and Development Services 8I*Lycg dp tun®nr
Building and Code Regulation Division unty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED'INPROVEM L®CATION° f ,.,of '
4
Address: 43 CZ 0 rr etv-e,/44-!'e
g p 2lJ 3531 I. A� '�`i NW/Cov cc cv Et' CTIC 5
Leal Description:
`t
less & /5 f+ (04)4C edf" Wo7.- 1‘71�
Property Tax ID#: Zr-732-` 0oOZT000 ` I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI1 L) DnCR PTION, WORK°
.
Cortrtrticf /levy-- 2ai, t-ci f carr, ee., afrt4 conn eeif Prem.
e`€e/.4rro 1 A/c__ s 51-
.C®NSTRUCTION dINFORMATIONo •zi a;., P
Additional work to be performed under this.permit-check all that apply:
M chanical _Gas Tank _Gas Piping; Shutters _Windows/Doors
Electric _Plumbing _Sprinklers- Generator _Roof Pitch
Total Sq.Ft of.Construction: Sq. Ft. of First Floor:,r:
Cost of Construction:$ ,da) Utilities: _Sewer _Septic Building Height:
;MER/LESSEE ; €ONTRACT®R .
0. .moo. n
Name 14Q?it (\ o YI e ) /� Name: Pd Pt / "ii€ y.
Address: . (7286 Holyme..i 1s JI ,lVe Company:_ /" Ivte F1eCfr C/ 1 y._
City: go c 4;c�) l'V i 1 fel State: Fi'— Address: Fad go' L - 55
Zip Code: 3 21.2-6 Fax: City:_ Ft- ll"e►rf.e State: �(
Phone No. 77x- 2- O- 2-1/DC Zip Code: 3q-97% Fax: '
E-Mail: Phone No 77Z- 42-9 - f 0 B'7
Fill in fee simple Title Holder on next page(if different E-Mail_
from the Owner listed above) . State or County License �R d 0 Irl 3 0
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP°LEMENTAL C®NSTR CT ®N LIEN PAW INF®RMATIONQ
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 forany restrictions which may apply.
•In consideration of the granting of this requested permit, I do hereby agree that.'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 ork or recording your Notice of Commencement.
Si nature of Owner/Lessee/Contr17/a4-0/e-)70/.__
fqr c I•_i , / •.:natu .of Contractor/License.Hold r Alle ...; 4%.:',4%,_.hA�:
STATE OF FLORIDA STATE OF FLORID - - 6i'*'
COUNTY OF •I.t,C—.1. a m COUNTY OF 5+ .1 cwt
The forgoing instrument was acknowledged before m, ; .= 5m D3 •The forgoing instrument was acknowledged befo • ��l
this.144___day of jA.4 4,7 , 20j by z ggm this"Of day of �(G-y ,20 e' by g�'EQ
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6i' T-p n Yt C
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E). ir.7 Ate- ' N22 mI , / . C 9,47
(Name of person acknowledging) a N (Name of person acknowledging)
,111111
al 0:.4,-0
(Signature of ary Pu lic-State of Florida) (Sig ature of Nota ublic-State:of Florida) �.
PersonallyKnown OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced { 0 Produced -lt--/n
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ,
DATE
COMPLETED
ley. 7/2014