HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1-9- l 1S Permit dumber:
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) 452-1578 Commercial I Residential
PERMIT APPLICATION FOR:
PROPOSED INPRO/EMENT LOCATION
Address:'. I UU 1 - -�-of-
Legal
f
Legal Description:
Property Tax ID 4: il L -J a. Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
amonal wOrK
---Mechanical
Electric
e performed underthis permit - cheek a
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ ;-�jt 600 . On
Gas Piping
Sprinklers
appy:
Shutters Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor. -
Utilities: —Sewer _Septic Building Height:
NameOCEiv:V i)i Q:.Ue CCDr-CJC A-3SLC. Qti Name: lk 11 { � G—
IL
Address: s0 J t Company:C-66 I AN r �Jtil� 1i�1S � P -IJ
City: Ve(-U I `+ State: E_L Address: (003 CG.bC'v—)C,' '
Zip Code: <3a9 (_yO Fax: --I City: SCA O i E( -CC- State: Esq
Phone No.' -1-1 �— � G - q6S 3 - Zip Code: 3L4 cis .�-
5 ` Fax: .11'9rJi, S3 !t
E -Mail: Phone No :1�;p-L-�)q — OLI C1
Fill in fee simple Title Holder on next page ( if different E -Mail CLL I oo r �Si Com -
from the Owner listed above) State or County License I C1 0o9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work ano installation as inaicaiea.
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 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
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Signature Owner/ Lesse on ractor as Agent for Owner
Signature —of Contract r Li e Holder
STATE OF FLORIDASTATE
OF FLORIDA
COUNTYOF
COUNTY OF
The fording instrume t was acknowledged 4efore me
The forgoing instrum nt as acknowledge fore me
—" 20 by
this day of to y
this day of
{Name person acknow edging )
(Name of pens n ackno ledge g )
(Signatur Nota Public- State of Florida }
(Signature of N y Public- State of Florida }
Personally Known OR Produced Identification
Personal! Known OR Produced Identification
Y
ARV Woody Ulysse
Type of Identification �y woody Ulysse
`AF�YPUBLIC
Type of Identification
Produced /.r-5, OTARYPUBLIC
Produced 613
-y STATE OFFLORtDA
� `s
TATE OF FLORIDA
Commission No. + 197907
Commission No.C� 1 �i-7 sM 7 - G'I97907
. ,�som(�i#E
8 Expires 3/1912022
Expires 3/19/2022
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014