HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /' f1 , Permit Nu
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Building Permit Applicati n
Planning and Development Services Permitting Department
Building and Code Regulation Division �t. LUCIe COUnty., FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line elee,4y,% 'QQ
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PRQ D r/SED IME? OUEMEN Lt�CATIC}f�1� kk r, r. ,,,�r %/ ���,
Address: 8303 NDIQTff BLVD FORT f0/SLE. �L � 95/
Legal Description:
i(U a&/9-80-7P)
Property Tax ID#: 1'301-• &66 —0/AP Lot No.
Site Plan Name: Block No. 9 7
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTl01 INFORM k N y/y i er /�,
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A itional work to be nertormed under t ispermit—check all appy:
❑HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
MElectric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 11,114 �' � Utilities: Sewer 11 of
Building Height:
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131 Or, /i ��,.F,,.
Name Name:
Address: S&e!>3 Company:0M-FDArCb1U OL S6W�S/AIG,
City: �b �i' �C State: P1 Address: ISD/ Sw ,8 Z7M6, 5 ST
Zip Code: 19z/g6_/ Fax: City: r17- 4ac/c State: �L
Phone No. 77Z 370 0/4—S Zip Code: 3 Fax: 772-76?r-
E-Mail: /7?i•/��//J�762) 0 olll Phone No.770 - 7?.-�"-90/0
Fill in fee simple Title Holder on next page(if different E-Mail: ki rn la-6 e4jg Q tnat ( Cor -1
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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M.LET, "Will
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
con-imencing work or recording our Notice of Commencement.
Signature o wner/Lessee/Contractor as Agent for Owner Signa re of Con ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6rZ_Me1E_ COUNTY OF S-r /_uCJ�_
The forgoin instrument was acknowledged before me The forgo�iig instrument was acknowledged before me
this T y of �TGf[-l� 20V by this�'f9ay of J-4(L y 20,[[_Z by
1- �LDf�/9'� 2 C Q0_'J �
Name of person making statement Name of person making statement
Personally Known�_OR Produced Identification Personally Known 3 OR Produced Identification
Type of Identification Type of Identification
Produced Produced
J r
(Signaturre�of Notary Vic (Signature of Notary Pub' State of Florida)
OPI(rea Notary Public State of Florida
Commission No. �' 1< 86JIWone Commission N� / �*"u Notary01&1�tateOfFlorida
t v My Commission FF 981391 = �� Kimla J Simone
of a Fjcpires 0511812020 c �,� My Commission FF 981331
?oF 11° Expires 05/18/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17