HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: V1 0T_
:R7
NOW A. - Building Permit ApplicationPlanning and Development Services ST. Ltting
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: To Select from dropbox, click arrow at the end of line
PROPOSED-IMPROVEMENT LOC_ATION;.
Address: 2 '3a7 erd
Legal Description: 3 3 o F 8 0M PT l E 5 � D sON'S 51P T AIT,
Us 01V sr V fi/,& F 1?1W V5 / - 6 AN N 61 PF 6r z5 M1��V
Property Tax ID#: 1'03 "113 - 0030 -O�O-- r Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
Replace 0 4 e 6 2-00A '3 fdme
gepIdte ON &) /00 � � f>d 4 tf
CONSTRUCTION_ .LN FORMATION:
Additional work toa nertormed under this permit-check a appy:
❑H AC0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑.Plumbing []Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
C 40
Cost of Construction:$ J Utilities: _Sewer❑Septic Building Height:
OWNER/LESSEE: ,CONTRACTOR:
Name 1241,i a d S peir Name: 126 14
Address: 0 0 ,'e Company: J0;Iz e Fre e-fi r.`c .l`, m c_
City: 7- ,m. d "/e YC State:_ Address: r/�- Oe �30K t7-/,7 5
Zip Code: D Fax: City: t7or I P1 e trCe State: FL
Phone No. 221 �U- 01 0 3 Zip Code: 3 if 7 7 Fax:
E-Mail: Phone No. 7Z
Fill in fee simple Title Holder on.next page(if different E-Mail: D
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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 rk or recording our Notice of Commencement.
C �
4
SignatuIW of Owner/L ssee/Con c ur
r as Agent for Owner Signate of Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF S't• LUc� COUNTY OF S
The for oing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this�day of ck\l t 20� by this�:�day of 120A by
�04; 'n Vire Cdr r�
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced yr L_ l L Produced L 1bL_
(Signature of Notary P lic-State of F -'i; (Signature of o J;yblic-St�@Wf" MJA8fyJNs
DEAN�`M� IE C�PJEPS th �:': MY coMtdISSIDN#DG 022023
'" og�loN tt GU 042-02' t'> "* (� IRE!'December/,Cp 20^
Commission No. MY FIRES:DersrttetlG.N�ca`nr1 Commission F NotatyPublfdCi�e�+I'
EX U�cieniri.. 1
public fit; �
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17