HomeMy WebLinkAboutDEMOLITION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9�Z��( $ Permit Number:
Ti
s �
Building Permit Application -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 COCTIII'lerCial Residential K
PERMIT APPLICATION FOR:,��vYva
PROPOSED INMOVEMENT LOCATION:
Address:
Legal Description: I-(i'dr)m,., I Iace- L spf tes ►-eco�led ,'�,, �'laf 13an�_, 17
0d" He_ 12L b(c e- !- CO 4_c cel` Sd . L,,-ci'C_ Cho, I-lyYPde,
Property Tax ID#: a3a'�-101- QO��-.C�bO-� Lot No. _
Site Plan Name: Block No. $
Project Name:
Setbacks Front '3 O/ Back: 20 Right Side: Left Side: 6
AF
CD;fTAILED DE�SeRIPTION OF ORK:
-�Cw�o sr� cf V.�z, ha rti l �/;�,,-�� ct hal...'F..`o K,,...0 fe(� 4 3 5 9 .Sc��'f: c�� . �x,'s'�i'c.a�_�-c�►,_a�.�� -
CO'NSTRUCTfON INFORMATION:
Additional work to 5—epertormed under this permit-check all that appy:
-L/Mechanical _Gas Tank _Gas Piping _Shutters _-Windows/Doors
Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: 1395 Sq. Ft. of First Floor:
-Cost of Construction:$ 2 zf 5 U Utilities: _Sewer _Septic Building Height:
OWNS /LggqEE: COg,T17
R,A-MINR:
Name [�tlev t 1 5Za u,w Name:
Address: 99991 k4-dde-,, Company: 1� c 134-�,L I� I ogl)-s the,
City: Fo�--t F State: Address:' / , 2 0,2-'k& U 1Z, AA
Zip Code: CW 349q5 Fax: City: 3u e►-- State: FL
Phone No. ('�ZS ) q 22 - O Y.5 i Zip Code: Fax:
E-Mail: L+% Phone No 5-61 -5-7 d on
Fill in fee simple Title Holder on next page(if different E-Mail �,.bh; ave i►�� . Ga V-K
from the Owner listed above) State or County Li nse
If value of construction is 2500 or.more,a RECORDED Notice of Commencement 1krequired.
S'IJPPLEfUIENi QL coN TR c` �aN L�._.., u1w I FORtMA�'1oN:
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.
Signature of Owner/Lessee/Contrao6r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA t STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi_Q�S day of by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi ation .Type of Identification
Produced
_ ---- Produced
•YP•.., pEANNAMARIEGIVENS (i
AIS ION#GG 022023 1
Commission No. c - MYC (Seal)
COCpl g.�cember16,20^0 �? Commission No.
=. o,. Bonded•p•' ThruNotaryPublicUnderwil9 r�$
.FOFF� � .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE .MANGROVE
COUNTER -REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED.
DATE
COMPLETED
Rev.