HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST B COMPLETED FOR APPLICATION TO BE ACCEPTED lee, 0 0
Date: 9. ) 6 Permit Num qt,, -,. 37,-,,-,--;: :
;F_E4 0 ;R ,t D.to AUG 2 8 213
Building Permit Applicatio
Planning and Development Services Pe'mama F ` , ' -,!-`}i ii
t.
Building and Code Regulation Division ,t, LUCie CO!.:"` i"•,, x-
2300 Virginia Avenue,Fort Pierce FL 34982 a_ft
2300
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 LLOCATION:
Address: ?Li6 I /E /Gu/I, ner I'd P573��5 7.,
Legal Description: RI Vat /31 A GLitor 7i a'T c
Property Tax ID#: V iq' o—ood q—000--...7Lot No.
Site Plan Name: Block No. 2 91
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION",OF::WORK:
/6462Aa i -,32,:r_ p,,, o `r.(7
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all hal apply:
HVAC I J Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
ElElectric 0Plumbing 0Sprinklers I I Generator El Roof Roof pitch
Total Sq. Ft of Construction: S9111.;of First Floor: i;
Cost of Construction:$ $ f trel Utilities:I Sewer lill Septic Building Height:
OWNER/LESSEE: CONTRACTOR: /
Name Ai'/Q f' Ilkm�th,t yr Name: ry ei
Address:3 d '�dt
o' f//4.0 LI' Company:/ -57D /2,1471 e
City: ,uyS7 n State:c# Address: 1'''/ 554) 5-474, 4',67:
Zip Code: 11 OW Fax: City:,f 51 4Ci p State:r(
Phone No. Zip Code:71(g57 Fax:
E-Mail: Phone No. 279--(3-V1--/ 7e),9-3/
Fill in fee simple Tide Holder on next page(if different E-Mail:e c4a3-7,4(oz,--,5& 1,CDi'"'
from the Owner listed above) State or County License: g7c?'?�6
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 Co encement must be recorded and posted on the jobsite
before the first inspection. If you intend . I-' financing,consult with lender or an attorney 6--- , ''"
commencing work or recor•-ng your No j_ . mencement. , i� a� .w ;-:
,...,/ ..;; ,,,A.-.:„..,
o _-'
_____AigivAll I., %,!;;;•••P %,
T<
Signature of Ow•fir a Contractor as Age vin r Signature of Contractor/ '- . der I x�c
•
STATE OF FLO• Di - g PA Q STATE OF FLORID / o f
COUNTY OF %f� ' �/—e- w 3= COUNTY OF �'1. atJ .z �:1
is ;.. '. I ram`; ;
Fi' 0T-O i S
The forgoing instru nt was acknowledge Lpe i fie' The forgoing instru��-,y nt was acknowledged ef. e T Ti ;ti
%� a �� da of , 20� b
this day of ��� ,20 b this y Y mN
Name of person making sta ent Name of person making stat en
Personally Kno _ OR Produced Identification Personally Know OR Produced Identification
Type of Identificati`'n Type of Identifi . ion, /
Produced AA ' l ` t— Produced //, - `
-
aitid z Iierilikist
40_ a,,,,,,,,,_65,
(Signature of Notary ublic-State of Florida)v (Signature of Notary State of Florida) pi
Commission No. (Seal) Commission No. (Seal)
1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17