HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 _
PERM IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IIVIPRC►.VEMENT LO:CAT,IyC?N f '�,` �c �,_ _� ��` ma„� '�� �,,,,_�� 'k''�
Address:01 ) 1 ros b PJ ace, PW Sf. (Alcie17--tl 3LIq,2(0
Legal Description: [ho 2(a cH` 4he- ��re, Q12ress QojMl- I fl;- 4-0-3
Loi- I(3 r be. 413)- -us3g)
Property Tax ID#: 3.3a 7' ^]J�'" C�71 S— — 6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks ; Front Back: Right Side: Left Side:
DETAILED DESCRIPTION SOF WORK U PS wi,
.a kir =,$ �` x , •.t,{ `'? t' �, .a r� °�:
CONSTRUCTION INFORMATION ;
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Acid
itional work to be nertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
` V�Name 'Qc-,b e ah Name: IDI—be— L
Address: 1(')fI 7 Qgos Company: OCL,(S,\Vas �1
2r1�,TrC•nn �
City: Po(t c
UkC�z� State: F-6 Address: a-icn ouc wuf p or-of�
Zip Code:; Fax: nJ C.- City: f-oft PI-er-Ce State: Fb
Phone No. 77Z_ —�C Zip Code: 3LI0% I Fax:-1'7Z-ZO-6gZ-?-
E-Mail: n.fct Phone No. -172— '373— &p O`7
Fill in fee simple Title Holder on next page(if different E-Mail: YY)QdCeaSP[Q&V108 2
from the Owner listed above) State or County License: CPG I'�}5Q(7n3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5
SUPPLE ME , TALCONSTRUCTION LIEN LAIR% INFORMATION r
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
kName: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR J%FFIDVIT: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 fist inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin ,work or recording our Notice of Commencement.
x ---- X
i natur of Owner/Lessee/Contractor as Agent for Owner Signa re Contractor/License Holder
STAT FLOtDA STATE O ORIRA
COUNTY OF ; r�� COUNTY OF dT - r}—LLC•LfL
The forgnq"ng instrume was acknowledged before me The r ing instru t was acknowledged before me
this��day of by this g�day of o, 0 1 K""by
n
Name of person making statement �' --game of person making statement e
Personally Known OR Produced Identification Personally Known OR Produced Identificationy
Type of Identi a ' Type of Id e tifi- ti
Produced 1r Produced C9V
(Signatuce-ofNot Publi - _of Elorida (Si ure`of Notary u to p.g,�IVART-WIQ
~�
Commission No. {
aTfission No, eat)r r
S otar�plih )tatS Of rthe" A
0
t }? (nt r t ?F 965)45 2
�;1,nsFeb.2 2020 �-• -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17