HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED
Date: I .- .
Permit Number:
RECEIVED ,
gig
Building Permit Application JUL.-0 6 20.18 It
Planning and Development Services
Building and Code Regulation Division ST: Lucie Gounhy,:Pia�rriit ing `
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553.- Fax: (772)462-1578 COn'1CYlercial- -Residential- X
PERMIT APPLICATION FOR: To Select frdi-6 dropbox, click,arrow at the end of line -
PROPOSED IM'P,RQVEMENT,LOCATION
Address:- 0 7
Legal Description:'--
Property
escription:' : . .
Pro a Tax ID#: - Z v 1 I,c•
2,� 2 Z U:Z 0
p rty - Lot.No:
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Riglit Side:, Left Side:
DETAILED'DESCRLPTION OF.WORK:
Z`(o Vd lOD vi7p Me �-j----�/Jd r- cc
`Zj,kr^ �4 c
Additional wor oe e orme un er t is perms -check a appy:
fVAC,.; f Gas Tank Gas Piping Shutters a Windows/Doors
Eectric: 0 Plumbing 11Sprinkle,ts Generator Roof Roof pitch
Total Sq. Ft of Construction: So. Ft.of:First Floor:
Cost of Construction:$ 9 S� Utilities: Sewer Septic Building Height:
OWNER/LESSEE. CONTRACTOR:,
Name /U��`I" �' . (7 f een F�`e Name:
Address: 31 07 S 1 P�Ilcrl Q +vv, D(` Company: \nr iCAV� I a4-
City: 41 C) r`17 Pi(Y"e State: FL Address: 3 5-o 4 izanknftek Ave,
Zip Code:. 3 L' 4 S?? -Fax: City: ?« e, State:F
Phone No, 17 2 — -2 Zip Code: 3 L( 4 Lf 7 Fax:
E-Mail:_ >Ol n�Q (W .5s, CoM Phone No. 7 7 Z _ �(+S�' 10 S 6�
Fill in fee simple Title Holder-on next page(if different E-Mail: yp`m U 4-Z M(_(4 o,:0 (;Ca`(h
from the Owner listed above) State or County License: _F G P 0 y 5-El 7.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONII.EN LAW fNFORMATIO:N:
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: _N ot"Applicab'l'e'_,
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 Hbrhe'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 T6OWNER: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 onthe jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordingVour Notice of Commencement.
Signature of Owner/Lessee/C ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA f STATE OF FLORIDA �.
COUNTY OF Sf. 66,`e- COUNTY OF Sf, -d4Lc '
The forgoing instrument was acknowledged b oras The forgoing instrum nt was.acknowledged b
this day of u 20J S this day of 201mMOZ
1 K Y . ,
Gf i`L �I h24v z �`c, Zvi .
Name-@ erson making statement w. erson making statement 3- Q
r K OR Produced Ident' canD ersonally Kn OR Produced Ident' on q-"
Type of Identification N Type o entification N c��'±
N to O Ci N Q �.
Produced ='o u, Produced
-.- .NGPe �
N G) m p> O
Wvi a
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(Signature of Nofary Public-Stpteef Florida) m (Signature of Notary P lic-State of Florida) -
Commission No. C6 (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE- MANGROVE
COUNTER . REVIEW REVIEW _ REVIEW_ REVIEW REVIEW REVIEW,
DATE
RECEIVED"
DATE_
COMPLETED
Rev.8/2/17