HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r1
Date: Permit Number: �J
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Building Permit Applica 20'8
Planning and Development Services
Building and Code Regulation Division y, Perrnittinn ,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:.(772)462-1553 Fax: (772)462-1578 Commercial Residential V/
PERMIT APPLICATION FOR:
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Address: Y205 �...',
9 5T p0'tii piew
Legal Description: r GK J 4t5 I O lot 17 owJ W3 f p tof b
Property Tax ID#: '[. O® ' wi5t" ow6 Lot No.
Site Plan Name: Block No.
Project Name: UUTWI: ELeD
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this.permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors .
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost'of Construction:$ OW. Utilities: —Sewer _Septic Building Height:
OEC�/ ESEE: ' CO T CTO
Names L I Name= '- LL giR, Foo-z'
Address: : W, 0; ;;, ;, ? Company:��1E
City: 6 Pj�l1�,e; State: Address:
Zip Code: /� Fax: City: 5 St
-/ ate:
Phone No. 71( 6-7o I Zip Code: 3It Fax:
E-Mail: OWE Phone No G�/ 0�
Fill in fee simple Title Holder on next page(if different E-Mail c fAVV cap . rye,
from the Owner listed above) State or County License n {1j 08
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: _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 th-at=may"restrict or prohibit such
structure. Please corisult.with your Home Owners.Association and review your deed for:.an.y restrictions vWch,may apply.
In consideration of the grariting'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
commencing work or recording our Notice of Commencement.
Signature of Owner/Les /Contractor as Agent for Owner Signature of Contractor/Li ense Holder
STATE OP FLORIDA � I STATE OF FLORI 11
COUNTY OF �I• {•A11,(/1.� COUNTY OF �T• ' '�
The forgping instrur,Bent was acknowledged before me The forgoing instrument was acknowledged before me
this X�L'day of 201. by this12;Tday of 20 by
(Name of person acknowledging) (Name of person acknowledging)
Signature of Notary Public- ate of Florida) (Signature of Notary Public= tate of Florida)
Personally Known ro uced Identification r>� Personally Known_ OR Produced Identification
Type of Identificati ny MA DE LA LUZ VELASCO Type of ldentific ;V
MADE LA LUZ VELASCO
Produced.' =• ruv CGMMI•SION*GG050399 Produced
EXPIRES November'28,2020 ' - MY COMMISSION#x'00050399
Commission No. "' (Seal)' Commission No. EXPIRES Nave,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ' SEATURTLE MANGROVE
'COUNTER , REVIEW, REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED-.-
DATE
ECEIVED`.DATE
COMPLETED
Rev. 4