HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: : / i Permit Number:
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Building Permit Application ss.,‘•,c9oe ?0�8
Planning and Development Services iP CO,'hi?j�,'r
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 . Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEM[ t l LOCATI®No . . r
Address:
�' 13 c_51)/ r) ( e TL yY a- /-PrCQ / 7"---1. 3-4- ? g' Z
Legal Description:
Property Tax!DU: ;4 I .O , G D3 • (Q 1 b • D DO 1 I Lot No.
Site Plan Name: Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
MrAILED DESSCRIPTION @ WORK°:P;.
. .
e2.----/--Ci 14 /C, -- 'y .1—•e' -},-- C.__k.O. (A_cd—e__, dOt_ Lt-)/ '67 (A)
CONSTRUCTION []fy]FORiMATIONo . , ,,
Additional work to be performed under this permit-check all that apply:
/Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ZD ' (2) Utilities: Sewer _Septic Building Height:
OWNER/LESSEE° ' CONTRACTO'R°
. :Name T la t.,`� 0Vl Name::. 9d r l S l b ✓i e C..( s a
Address: „S---7-1'2 Sp.l:V\e ( 2_ p L ' -- Company: Sq S UL. e t 21 td I V
City: �4 — p.''''''''`-e— State: 1 Address: °`'i 2 i1�7 ''tV l 9-1(7 C(, Wt
f'Zip Code: L:t., //Z .Fax: City: 5 .. ... State: fi
Phone No. —Isl. C�—(O l — 5-S— I Zip Code:�a4? K Fax:
E-Mail: Phone No 77 Z— 4. 0 g - -7 b1 7 ,
Fill in fee simple Title Holder on next page(if different E-Mail �C0 e L isI O O • C,a--7
from the Owner listed above) State or County License i4 C.,.. ( )S 1 7 6 7 (;‘,
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
SUIP"P"LENIENT I CONSTRUCTION'EltN LAW,•.I 4F,ORMATIbNo. ,1-' "A..' '' .-1-1.:t-',.° ;f
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
comm-• ing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF - �n - STATE
COUNTY OF 2e _C -
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me .
this I day of , 20 q by this ( day of j ^^-<--) ,20 I5 by
fjv-, S CA i s Z.J✓ S (az Vt Q�S
(Name of person acknowledging) (Name of person acknowledging)
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1 G ...
,,
( i ature of Notary Public-Sate of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identificatit5n
Type of Identification Type of Identification
Produced _ Produced F-t,( �
,.��Pn '' KAREN S. NIELSEN l ,;;tJP;a, KAREN S. NIELSEN
a°�� `ck..State of FI Notary Public l + `�'cS,[atte pf Florida-Notary Pub c
Commission No. _4,-.1.,,v.,..++iqp� Commission No. .= 1� }}+,ssion# GG 207ns4
t CommIS5 71 GG 207h84 ;�+diJ�ct: PA Corn'rnission EX If�9
,741;I ":�. My Cornmi on Expires '%,;;orejP,°, y p
'r++++�"� June 12, 202
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014