HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U'(` - 1 Permit Number:
s `�.J
1111, 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 it
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1 /-' A kA
Legal Description: i A c1 r\ q kA ,cL
Property Tax ID 9: 1 `4 .�a � - -7 0-1 - 0 _�," i - 0 C) 0 41
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
L C_,C.- s ; •, -��- 1(�#�ik _
L,4c L -r—,
jaitionai worKto t)rtormeci under this permit -cl
OHVAC InGasTank �as Piping
Electric L:i Plumbing OSprinklers
Lot No --
Block No.
apply:
_ Shutters Windows/Doors
0 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of ConstruWon: � �(t iii- Utilities: OSewer ®Septic Building Height:
OWNER/ MEE;
CONTRACTOR:
Name C,:, i`iriC
Name:
Address: '7 D,� 11..1 • A k A � Ue,,I+ J- (0_�
City: IIL 0. ef-[kState_
Zip Cade: ?rr{ Fax: &:14
Phone No.
Company. l,,,i lvi�.
Address: qqt Lre
City. ErL<
Zip Code: Wti
Phone No.S�-
State:_)2_
Fax:�-
E-Mail:
Fill in fee simple Title holder on next page ( if different
from the Owner listed above)
E -Mail: (t n, c. n c C?_
C. ciY�, C-st
^
State or County License:
v�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: --- !
DESIGNER/'ENGINEER: _ Not Applicable I MORTGAGE COMPANY: Not Applicable ;
i Name: Name-
1 Address; Addre=s.
City: State: } City: State: '
I Zip. Phone Zip: Phone:
FLEE SIMPLE TITLE HOLDER: Not Applicable ! BONDING COMPANY:T Not Applicable
l
Name: Dame: l
Andress, Address.
City • �_ity .
I Zip. Phone, I Zip: Phone. I
OWNER/ CONTRACTOR ArFFIDMT: 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.
I
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is i€� contirct 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 jehsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signat - Lesse Conti as Agent for Owner
1 signat ractorJLicense Holder
4
;E�OF
FLORIDA
OF FLORIDA
COUNTY OF c.'
COUNTY OF _f -�
The forgoing instrument was acknowledged before me
qday
The fo ging instrument was acknowfedged$efore me
`day
this of �u�� 20� b%y
this of 2€T by
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Name of persort.making statement ,
fume of person making statement
Personally Known �i,,--' OR Produced Identi
Personally Known OR Produced Identification
Type of Identification = �=
_&,-I-
Type of Identification
b�
i Produced :, •Cr
p'�+uwaMai
Produced:-
opyu,n,,,
i
(Sig Lure of Notary Public- State of Florida) 3
(Signature of Notary Public- State of Florida 1 "�t�•"'•'
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Commission No. (- cl s (Seals w C
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Commission No. (Seal)
Q O
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REVIEWS
FRONT
ZONING
Sbi,1I~VfS0R PLAINS
VEGETATION
SEA TURTLE
-P +�
COUNTER
RFVIE11li'
REVT)%' REVIEW
REVIEW
REVIEW
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RECEIVED
o CL i
DATE
COMPLETED
Rev. 8/2/17