HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: S41(24- 7°4 Permit Numbe • 11° 57
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Building Permit Applic.:tion
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: a01?,,.._0 _b_
PROPOSED"ONPRDVEM LCATI,ONo / a
Address: (35Cz .ce-t /!'Ov✓2re i t. 07n vg„ �1 J ' ()
Legal Description:
Property Tax ID#: ,3 0 S-131 S7- 0 D0 19 s Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAUR DKCR PT1ON WORK°ry . . , .e "
-2 -1i(A ,u2eJr P
CO °STRU,CT(ON OmFORIVI'A TION? _
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric —Plumbing _Sprinklers Generator /)..A<; ' / Pitch
Total Sq. Ft of Construction: /4)-2)(2 Sq. Ft. of First Floor: � -N,-7- (17 1
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Cost of Construction: $ a-(% ', Utilities: _Sewer _Septic Building Height: /(3
OWNER/LE-SSSS` Eo - o . ", ,CONTRACTOR?° " " _ R2
Name USSi 'f//O Name: 1 3 ,‘,4„) �-r�c�
Address: - 6(o a Sect l 045--e_ �'".._ Company: �//24 r e %1� . -
i r
C ty: Ur r p��-L,,,. G). State:_ Address: ea-1)46 �p/7/at
Zip Code: 3 L( C i Fax: City: ' State'
Phone No. Zip Code: li?i, Fax: I
E-Mail: Phone No 2 7� f.6 '7D--,3
Fill in fee simple Title Holder on next page(if different E-Mail /�"Nf��4P 6P7c./
from the Owner listed above) State or County License 666-`g7yr7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
R tM:ENT�1 L CONS RUCTION` �. ,; VORMATI 0€ "�
I 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
commencin: ,.r .., ecordin: our Notice of Commencement.
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Signatur-'.r e' °er/Lessee/Contractor as Agent •ti` r"+ .,:,t Signature of Contrac % License Holder
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STATE O FLORIDA ,� STATE OF FLOj
COON OF ,, t. . •' COUNTY OF . e�C ��t�:»',r.•.
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The f rgoing instru ent was acknowledged-befor- a mac The for oing instr ent was acknowledg be,+> ;rrf'=
this �day of - ,20 by u,�, this day of Z ,20a- b` .
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TTO" .0 . e-l� - n st% 16 h y rO -Iefr. ,<o0
Nam of person making statement. g o Q ' Name of pson making statement. F Jam,
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Personally Known / OR Produced Identificati a N Personally Known OR Produced Identi' tin 2
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Type of Identification Type of Identification R.c8.�
Produced_ Produced 1 8N
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(Signature of N�ttary Public-State of Florida)— --- "/ (Signature of Nota L ublic-State of Florida) ,
Commission No.V (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17
1