HomeMy WebLinkAbout4233_001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ti. Permit Number:
J
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 s Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 005--��1
Legal Description: WwAe'+r � U _
Property Tax ID #: is_5 z Lot No._ _
Site Plan Name: "_ o cxa_uu_-��_Block No.
Project Name:DM
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Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CN�qN*
CONSTRUCTION INFORMATION:
AcIditional work to lop er armed^ un er thisperm t - checl all appy:
?VAC Gas Tank 0Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing ❑ Sprinklers D Generator E]Roof Roof pitch
Total Sq. Ft of Construction: �^�, S . Ft, of First Floor:
Cost of Construction: $ _heV - Utilities:D Sewer [J Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name •� ` CX
(N Name: t LAi,,,r, �?I_ C'%, 'I �
Address: u s c r v Company:
City: State: Address: v
>bLe
Zip Code: 5 Fax: City lltitiLa �r a ,cc. Iii` _ State: C_L_
fir`? i r C0 �"t -2`t - �{
Phone No Zip Code: Fax:
E-Mail: f Phone No.'��-2
Fill in fee simple Title Holder on next page ( if different E-Mail:k-(1 ' pY
from the Owner listed above) State or County Licenser 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Rev. 8/2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 holier 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
I
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.
essee/Co r-tor as A en or Owner
Signature of caner/ Lessee/Cot
Signature of ntractor/Licens H Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ��PzV1 �_1')`QJI{L
COUNTY OF �C� � L
The forgoin instrs� ent was acknowleclp fore me
The r-oing instLuV?ent was acknowledge fore me
20t-Y
this Qday of �'�,Q,,. 20.1 by
this of �.�J ,
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known �OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur of N tart' Public S Iorida
(Signatu of tary Public- State of Florida )
JOYCE ItiCHAUD
Commission No Q ' (Sqw�OMMISSION FFC
mmission NAT � ' `r"r,� Sea YCE MICHAUD
3G�f
EXPIRES: April 25, 2018
MY COMMISSION N FF 083006
A
Bonded Thru Notary Public Lin
IS } P
IKES: Apri125, 2018
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE--
RECEIVED
DATE
COMPLETED
Rev. 8/2/17