HomeMy WebLinkAboutBuilding Permit Application �A
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i ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Y > /n
Date: 72C Permit Number: U !.• "' ��
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Building Permit Applicati n JUL 5 2otE
Planning and Development Services
Building and Code Regulation Division PeEII� InC �E,�ntly lent
2300 Virginia Avenue, Fort Pierce FL 34982 IL il
Phone: (772)462-1553 Fax: (772)462-1578 Commercial dhJ€i FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT-LOCATION
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Address: 6'76 69C a I c,, 1"1�r P C,9-c+ P%eS GQ_ ' L.
Legal Description: Lo_ V-4-uuGincX 0 a ►4- 16 eA V k 3 l Z-04 1 2-
Property Tax ID#: Z - 623, 420- Zr Lot No. t Z
Site Plan Name: Block No. i
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
D A(b 00 c' i X 7 �pC_
CONSTRUCTION INFORMATION:
Additional work toa er orme under this permit-check a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
c�-(7
Cost of Construction: $T�� Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: (, k6e c4x1 2 -R, v S
Address 6 7U-3 e Company: FZ r e_ r" e 12ond' P..r+s L L C
City: (-4- R P...r Ce State: Address: 8-7/6C.e-3
Zip Code:3 q Fax: City: State: C
Phone No. ?7 Z..-3:52- 7 kiQ Zip Code:,fit{4 b'3 Fax:
E-Mail: Phone No. -1 7 Z jX 7 `L3 6 Z_
Fill in fee simple Title Holder on next page( if different E-Mail: to &-C4S(?9- u(�haa.c.N
from the Owner listed above) State or County License: 30,5Z!2!
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: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: / Address:
City: / State. City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HO ER: _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 thepermit 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO STATE OF FLORI A
COUNTY OF '�L.t C�-Q COUNTY OF ;kc Le
TheArgoing instrument was acknowledge before me The forgoing instrument was acknowleclg4before me
this-,4---1 day of ..S 1 2015- by thiX 11 day of 2010 by
Name of — \ making statement Name of er on making statement
Personally Known s ` OR Produced Identification Personally Known�OR Produced Identification
Type of Identification Type of Identification
roduced P o uced
(Sign ture of Notary Public-Sta -otF1ori (Signat re of Notary Public-State o
o )MO
RAMOS ti�". MORAIMA RAMO
?:' N � ISSION#GG156738 zo`..."`
Commission NoC1C'1�b _.p Commission Nd �W �:7 +;, YCOMMISSION#GG 5 38
EXPI ES:OCT 31,2021 . EXPIRES:OCT 31,2 2
Bonded
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through 1st State Insurance
-It®tided through 1st State I ist ince
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA-TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17