HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �os'on
Building Permit Application,
Planning and Development Services
Building and Code Regulation Division _
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATIONFOR:FOR: [To/�Sel♦ect from dropbox, click arrow at the end of line
P..4e � � 11�t7CATIC N °�✓rc". F 3
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Address: StfCc-i
Legal Description: S-CChim 05 own 3U5
Property Tax ID#: 3405 441 000 Z. DW -7 Lot No.
Site Plan Name: �C7t�IC Block No.
11
Project Name: �.-Q C,KP
Setbacks Front Back: Right Side: Left Side:
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Additional work to e er orme - un rt er this permit—check a appy:
❑HVAC �_Gas Tank Gas Pi _ Windows
❑ in Piping Shutters ❑ Doors/
Electric ❑ Plumbing Sprinklers E]Generator E] Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$.1%00 -00 UtilitiestSewer Septic Building Height:
E Y IF 1 ? x9Y2 4 4fy
C► "�ER��E �E t ���f N RA (C?R�
Name l=e, Name: G OVL t IWr)M(_6+
Address: SM S 2,51h ��t�� Company: -AQl
City: V7 --1�� tcfc-r— State: P_ Address:na) W 114 S_wm�
Zip Code: Fax: City: Mtam I State:
Phone No. Zip Code: 331JCDv -Fax:
E-Mail: Phone No. 1 17 4qi)5 —11®4
Fill in fee simple Title Holder on next page(if different E-Mail: j�o(-J-�Main@arnou I. Com
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: te"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 thepermit 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
befor he fir t 4spection. If you intend to obtain financing, consult wit len r an attorney before
co=e cin o r/rp coAng your Notice of Commence n .
AI V
ureofP&VrLike(WUntractor as Agent for Owner Sig ture o n ac r/License Holder
STATE OF FLORID . 11 '' '. STATE OF FLORIDA,
COUNTY OF �� I.I.t�� COUNTY OF �Q [.it
The f r oing instrument was acknowledged before me The fo oing instrument was acknowledged before me
this day of. 20J by this ,day of 20 18 by
Gtan,A rnhnrrlt. Ca
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Name of person aking statement Na a of person making statement ✓
Personally Known person
Produced Identification ✓ Personally Known Le!� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
AV. CONN 1 1�[ Y /`�" 's"`
ao
(Signature of Notary Public-State of Florida) 7=2
f Notar Public-State of Florida
NICHOLE ARO tJIC OLE APONTE
Commission No. )State of Florida N �Prllllu
.+ r I No. ►RY°�e, Stat ®9 orida-Notary Pu 1i
4�; Commission#F ;_ `�� Commission#FF 963031
Expire _*Comm. My Comm.Expires 05-04-2 2 d Thr Bonde ;; oP�, Bonded Throughfet I, OFR
REVIEWS FRONT ZO G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17