HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED gh,I (I`JV72
Date: Permit Number: t I
COLI NiNil-Y . RECEIVED
F H. O R 1 Q Pt
Building Permit ApplicationiuNlj.20S
Planning and Development Services Permitting Department
Building and Code Regulation Division St.Lticie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATIONS
Address: —7() re" 1 r i )Ci rc ,CJJ , ri - Pier .Q f 344
Legal Description:
Property Tax ID#: 3402 . (o ( Otip3 ' 0 ( 0 • `o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEFA LED DESCRIPTIO OF WO a Ka.' 1-� . ' MAIM
-e Qp\ f L Q -crib() d C 1,4,3D-OC G�� - ,,rC_ S 1c)1 -C'
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CONSTRUCTION DFORMATIONo
'Additional work to be performed under this permit-check all that apply: . i'C--- 3
_Mechanical _Gas Tank _Gas Piping.. _Shutters _Windo s/Doors
Electric —Plumbing _Sprinklers ' —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ I 'ia)f)C>D e3o Utilities: _Sewer _Septic . Building Height:
OWNER/LE=�S�SEE2, . ° . • ' CONTRACTOR?
Name�(X, IP �Sp 1�. 1 f eC Anash Name:
Address'7D� 0 _ 1 i26 Company:
City:f3 - Q1.er ( State:- Address:
Zip Code: 3L164,g d Fax: City: State:
Phone No.Ti) -i- aC .)-- Li-a1 '' Zip Code: Fax:
E-Mail: LS J'tz) ylgerp hcyinini J.,(CAfro)e No
Fill in fee simple Title Holder b•f next page (if different E-Mail
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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&SUPPLEMENTAL CQNSTRutthN'LI N.G�' e ®ft+MATIONg ' a4 • r. 6
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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 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 fulf_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 your Notice of Commencement.
Sig ure of Owner/Lessee'Coactor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA SATE OFFFORIDA
COUNTY OF c1-• O
r
The forgoing instrukrient was acknowledged before me TKI%fct,,ing instrument was acknowledged before me
this 21 day of _ 1. t•►._ ,20 & by . f is day of , 20 by
w 5e(#�v Rc4,5 x ��
Name of person making statement. J rgais person making statement.
O ¢ 2
Personally Known OR Produced Identification Ev •-y Known OR Produced Identification
Type of Identification Type_ar '•entification
Produced ;R tritK.
l./l -et } '. ,:air•
(Signature of No ry P lic-State of Florida (Signature of Notary Public-State of Florida)
Commission No. _ (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-iev. 8/2/17