HomeMy WebLinkAboutbuilding permits ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S-sl-r-s Permit Number:
ak
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)4e2-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address-, 5-70D b,.)i kr Qo✓tyan �k
Legal Description: Llkictwnn6 (far k i,.kK-+- It 91k I l_o-v l'�
r
Property Tax IDfi: I-5Ok 60 -O'� 601 -- c, L( Lot No. l"?
Site Plan Name: Block No. 15a
Project Name:
Setbacks Front Back: Right Side: Left Side:
LaETAILED DESCRIPTION OF WORK:
�c�-rzt(f f1r'etncnt-( -k-"ran5�.,- �n�.[ � pJr�.4.C.e [�nwY.-fvr ear
6.-K czncl k nvC� �i�
CONSTRUCTION INFORMATION:
Additional work to r orme un er this permit—check a apply:
0HVAC []Gas Tank F]Gas Piping _Shutters Q Windows/Doors
aElectric 11 Plumbing OSprinklers D Generator ;=t Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First[Floor:
Cost of Construction:$ g00.a� Utilities: Sewer DSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: J S�uW I
Address: Pifwy Company:
City: crc _ State:f-4- Address: Cat{A Prt-5 r Lr\
Zip Code: Fax: City: -F* P a-re-y- .State: f--L-
Phone No. 17-I'-- J O g16I 1 Zip Code: '2,Ki i a Fax:
E-Maik ( e Mott , Phone No. ??-k- o� 16- 5-15A
Fill in fee simple Title Holder on next page( if different E-Mail: LAJMt �Ac C4Im C et> .AW_f�
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: o 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 instaliation 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,
accessary 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,
�r
Signatur ner/Less or ascf Agent fo caner a na e Contras ense Helder
OF FLORIDA ATE OF FLORIDA
COUNTY OF_. Sk LA-tat COUNTY OF L-,Ac:e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 11�4day of AvAc, $i .2011 by this�day of �11y�%4 ,20 Ill by
'Y444Jr' �hGtr n L')J '6
Name of person making statement Name of person making statement
Personally Known ✓ OR Produced Ideri fication Personally Known ✓ OR Produced Identification
Type of Identification Type of identification
Produced Produced
(Si ture of Notary Public-State of Florida) (Sig re of Notary Public-State of Florida )
Commission No. _(S I q� 5qf
ommission No.rT' S
•L��pv b4�•y :j0 •r i JaSQ
a or,,y JASON M RAULERSON N fM RAIJLEFiSu�; 4
2 r = = Notary Pubfie
COMRCV(FWS FRO T'•• HIV f:omml "sten ar Ff 96554fi LANS VEGETATIO ••` `'f{JMLtCo � P # FF y 59 it
' ,.��. I+Iioomm I����' o U n f3I�v9���`�B. o
Cott IEW EIEW REVIEW
DATE
RECEIVED
DATE
L.SOMPLETED
Rev.812/17