HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 401- 04,91
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Building Permit Applicatio
Planning and Development Services SEP 18 2018
Building and Code Regulation Division - r-1
Permittin )n
2300 Virginia Avenue,Fort Pierce FL 34982 5p art men t
Phone: (772)462-1553 Fax: (772)462-1578 Commercialt lesfitertt'ab-LP-CS I i n i-y, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end-of line
D-' bicAtioN',
PROPOSE' IM
PROVEMENO
Address:
Legal Description: Ar
Property Tax lD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
' DETAILED I DESCRIPTION OF,WOR
D i z)ro 5ku-KefS
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CO'NSTRUCTflOWINFORMATIOW
Additional work to be nerformed under this permit-check all apply:
11HVAC Gas Tank E]Gas Piping Shutters Windows/Doors❑
FlElectric Plumbing OSprinklers 1:1 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities Sewer E]Septic Building Height:
R! ,
OWN'ER/LESSLEk ,CONTRACT
NameMkh
ry,0
Name: io
Address: Company: F_Y-j-,o-v i ors Thr,
City: -Ir State: Address: 'S-f ,
Zip Code: I Fax: City: P,61 State:
Phone No. Zip Code: :3uCRY3 - Fax:—
E-Mail: Phone No. --77 C37-3 -0(ow
Fill in fee simple Title Holder on next page(if different E-Mail: 1�2 C)NL+-P_ri 6Y,5 -dopl'q
from the Owner listed above) State orCounty License: 0-nd 1260 /a50
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPEEMEiliTALC4NSTi3UCTiON Li.E� LA�IX! i#�IFORIVIATION � _
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.
1 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.
Signature f Owner/Less /Contractor as Agent for Owner Signature of C ntractor/Uce a Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �Cc4Ci, COUNTY OF 9-Gu m
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 'day ofiSP�N' .20_Jeby this /qday of C' L ,20J by
"'Fi�►11`i.��x Ifo, 7-rl;para.
Name of person aking statement Name of p
pers n making statement
Personally Known 0(OR Produced identification Personally KnownCX,, OR Produced identification
Type of Identification Type of identification
Produced __ Produced
(Si re of No779
(Sig to o otary Publi - f i rich
Notary Public State of Fbrida State of Florida
Jos ane Alberico Co m ion No: �FCo fission No. My mmis Son GG 020879 K �� ne Alberico
Expires 08/16/2020 My Commission GG 020879
of w Expires 08/1812020
044 Aa 040
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev,8/2/17
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