HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: q//Z/// s Permit Number:
RECEILED
Building Permit Applicat on
SEP 1Planning and Development ServicesBuilding and Code Regulation DivisionST. Lucie Coil�
2300 Virginia Avenue,Fort Pierce FL 34982 v
Phone: (772).462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INRROUfMENT LOCATION:
Address: 3ZS( Vejr 1)ir- F4 P ecce /`L. 3cfel�s1
Legal Description: R60 laces 16 k 7 bar -I-k j 4e L& c,o-�c e rJDoV
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front k Back: Right Side: Left Side:
DETAILED DE�SCRIPTlON OF WORK:
�eA(car2 ck-, .-1"iii 9arrp y Jgn i-. &J.( -k- Se{,ntic -6ize— f-/ci.ct 5 eianc--
CO'NSTR CTIA !NI°ORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ' Utilities: —Sewer —Septic Building Height:
OWNER/LElW EE: OONTRACTOR:
NameeT6r-t- -t-Ac,ma 5 Name:
Address: 3 ZS/ - Piave;, /)r Company: A-r�cL► F,arcy;& doo/-
City: ja- 'i'c'ce- State:_;G Address: /.?/L/C)
Zip Code: 5e/c/k/ Fax: City: /7$'1- State: �C
Phone No. *370 Zip Code: 596-3 Fax: -
E-Mail: Phone No 772-- S2S--j"YZ r
Fill in fee simple Title Holder on next page(if different E-Mail ic 4z"Uze . or✓L
from the Owner listed above) State or County License
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SiJPPLE ENT' L C�N4 TRUCTION MIN W.W I63'111
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 work or recording our Notice of Commencement.
r
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LAI-. COUNTY OF_�
The forgoing instrument was acknowledge before me The forgoing instrurpent was acknowledged before me
this\�day of 5��� 20 A by this day of e �- 20E4 by
Ss
a, c T C. 6 �q
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 Produced
(Signature of Notary P lic-Stat D RI#��o p23 (Signature of Notary Pa 11 of i I SSION#GGo22o23 E
.P, MY r 16,2.020
GO gA1SS��Q pet 96,2e �e� o EXPIRES:DecePub II c UndervariteF
Commission No. � �D a t�C Lc��y
F,CP1 publlcUn COmmISSIOn NO. {� gonded'T
.a aedfiNNotatY
Bon 1
r
REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7