HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: (�
Address:' C -} 3) erco }c v tib 11
Legal Description: fin, re1�i 1 �i tn1�- 3
PropertyTaxlD4- aLAU% -
Site Plan Name: �Va5kr,
-2
Lot NO)
roi /16 It !' { Ic�' (D i�'6 — I I,34BIock No.
Project Name: (Nbk- . fy\-d 0C'\ 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORD:
gip ' ' C,�a l Y`� 1�G,; �rz2. iin)4-
CONSTRUCTION INFORMATION:
Additional work to bjer)ertormed under
HVAC L J Gas Tank
this permit — check
Gas Piping
allh
apply:
Shutters
Windows/Doors
❑ Electric ❑ Plumbing
❑ Sprinklers
11 Generator
Roof Roof pitch
Total 5q. Ft of Construction:
S Ft. of First Floor:
Construction: $
Ob
Utilities:
ElCost
Sewer Septic
Building Height:
of
OWNER/LESSEE:
CONTRACTOR:
Name
City: fes ', �/ Stat -6- -
Zip Code: L{C[ _ F
Phone N
E -Mail: Zvi c_.e eD c,:-, ttnsk-r), `{ 4Jn 1 nc .
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: \6y1 CP_04- CCLII C1D
Company: Inc
Address: k011 W E J-CrrSen 3651, Z31
City:-zX---ls�1 zmGh Stater
Zip Code: 754c\ S l 0q - (,o aaa,
,hone No.3r�Z i Q 11
�J
F -Mail: r Y3 (� Q i -f cv1 czn5` (-,) c4,'pi a 'IC -
State or County License: Sl —_I1 B l
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and cavenants 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 firs spection. If�{ ou intend to obtain financing, consult wit�'fender or an attorney before
commencing ork or recoWng vour Notice of Commencement.
Rev. 8/2/17
ignature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `Cy__',Ct,2�—\'(_)
COUNTY OF �[1i�7L'1n
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisN3 day of �.p . 20 _LSSby
this 9 3 dayof _ J, � 20_L
`f � `r'
� � (-� UJ -4 C—f r'\ (-'
Name of person making statement
<K
Name of ers n making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No
�y: '••ANIELLE ZIELINSK!
(Signature of No I ri
DANIELLE ZIELINSKI
= Commission #
Commission No. _ _�92
'W' =
Commission No. _.: :�_ Cammissiorr#F145l2
o+a. xprres October 93, 2019
=� =- Expires October i3, ?099
".°, � Bonded Thn Troy Fain lnauronm iW l6'5-7019
"4'F •.•• e�,•
R� Banded Thu Troy Fain Naurx¢e g00185.7019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17