HomeMy WebLinkAboutBuilding Permit - HOUSE All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) _
Date: Permit Number: -C6
•
a 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
PERMIT APPLICATION FOR:
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Address: o'? ALJ 1 Za-(�W-4P ,v q) - �:�(+ PI e c't
Legal Description: F(eet cxOCT-(, S rjI e- 6 + 3
0 . 3ko FSC)( O <f-1l- LFSI
Property Tax ID#: o1L{a L.P0(i C3dv '(-P Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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3 o(b -bs P2O-CPIrl lig -f-g q5 �0 COA . (n St-4 I( rJ
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator hof Pitch
Total Sq. Ft of Construction: /&," L# Sq. Ft. of First Floor:
Cost of Construction: $ l,-3y C) , Utilities: —Sewer _Septic Building Height: -7-/o-
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Name Cvlr/ SCh64le Name: J CF(:77"P ea +-1
Address: dqo / \?a be^ Av4 Company: Lst Lu If 0 C)
City: ( State: , Address: 5 R.l 1 VlA C1LIM b
Zip Code: _�j�GLK a- Fax: City: I���f 5't�Ct.�� State:
Phone No. r? - a 5 - O9 3 r"? Zip Code: Fax: ?'? ----'vr?-`?�)S
E-Mail: efef-Mu 4-c.. �d h� C�jv� Phone No ` J"-?,} - 3-f\-( 2-76
Fill in fee simple Title Holder on next page ( if different E-Mail + I L4 c 1-f i 0,3C-�!/I ci x")00 . WW1
from the Owner listed above) State or County License C 1 J
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
..
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 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
commencing work or recording our Notice of Commencement.
Signature of Ow r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI A t n
COUNTY OF -rr1,LkC� L COUNTY OF t `�
The forgoing instrum nt was acknowledged before me The for oing instru ent was acknowledged before me
this I day of 20 L 4by this I day of 'ti 20 1�'by
P �eL ��i M P�0 a°
Name of person ma ing statement. Name of person making tatement.
Personally Known `� OR Produced Identification Personally Known ~� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
.57��.
(Signature of Notary Public-State of Florida ) (Signature of Notary P e of Florida)
;;�«� CONS ANCE PROULX „��!"''' CONSTANC PR
Commission No. 'se: ���a�j OULX
MY COM 910N#FF 160517 Commission No. '= Y COMM155TON#FF 160517
=� .. EXPIRES September 16,2018 %,a�, EXPIRES September 16,2018
(407)399-0 53 Fbrda oFwdallotarysoom
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17