HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BEACCEPTED
Date: ,,'`L.25-11,6 Permit Number: ` 0
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WRIA
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
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PERM IT'APPLICATION FOR: To Select from dropbox, click rrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Co•-�.•1or.r3� f�� .',, i�. o�T , c nc.� L.
Legal Description: v'een L ort 5741-25-6 S
PropertyTaxlD#: Lot No.
Site Plan'Name: &L>ce✓I Z, _ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
sr)V Ged�`70� i a
CONSTRUCTION INFORMATION:
Additional work to' e nertormed under this permit—check d1l appy:
❑HVAC Gas Tank F]Gas Piping _S utters ❑Windows/Doors
Electric Plumbing FSprinklers G nerator Roof Roof pitch
Total.Sq.Ft of Construction: Sq. Ft.of F rst,Floor:
Cost of Construction:$ f!24 b Ga Utilities:o Se er E]Septic Building Height:
OWNER/LESSEE: CONTR CTOR:
NameJ�o•�� I���)c�so� Name:
Address: 13` C�o:n-�+o.�r�se�t 1{ C �r�� Compan
City: State: Address:
Zip Cod''&': Fax: City:4:w '� �( i e/LG� State: R_.
.Phone No.�,4-772 4 '-910 j!1e//-77•Z-Z(�o -�q( Zip Code 3y9 1 Fax:
E-Mail: a/c�o.✓�.Id r�l�Le15,-.�d•-it e t- Phone N 7702— 3302- 1 aiS(p
Fill in fee simple Title Holder on next page(if different E-Mail: '� o�n e-� ldc:r5 .y c,A-s .'
from the Owner listed'above) State or ounty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN 'LAW INFORMATION:
DESIGNER/ENGINEER: X 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 r and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your eed for any restrictions which may apply.
Inconsideration of the granting of this requested permit,I do hereby agree tha I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Luci County Amendments.
The following building permit applications are exempt from undergoing a full c ncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and a cessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commenc ment may result in your paying twice for
improvements to your property.A Notice of Commencement mu t be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, cons It with lender or an attorney before
commencing work or recording our Notice of Commencement.
Si ature of owne/Lessee/Contractor as Agent for Owner Signature df Contractor/License Holder-
STATE OF FLORIDA STATE Of FLORIDA
COUNTY OF COUNTYF
The forgoing instrum t was acknowledged before me The forgoi g instrument was acknowledged before me
this,70' day of u 20 /5' by this d 3y of 20_ by
x) nnJR IC SOIJ
Name of person aking statement N me of person making statement
Personally Known OR Produced Identification Personally nown OR Produced Identification
Type of Identification Type of Id ntification
Produced Produced
(Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida)
o1,AY PCOLLEEN J HOLMES
Commission No? '• °"' IONiIJ Commissio No. (Seal)
E)SRES:June 9,2021
i9lFOF f�°�O�Borbed 7W Budget Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17