HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�7 Permit Number: t'O D(O?
ytF_L, d i}t 1 D:02!. —
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 Commercial Residential -)
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PERMIT APPLICATION FOR. To Select from dropbox, click arrow at the end of line
PROPOSED IiiIiPROVEMENT LOCATION �N u
Address: L(' 32 Wok}cf4st,n Wow/
Legal Description:
Property Tax ID#: )6 3a-5-0 0- no s--3; 00n- I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIOl�
CONSTRUCTION-INFORMAT1ON sr
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Additional work to bpp erformed under this permit-check all apply:
HVAC I l Gas Tank EGas Piping Shutters ID Windows Doors
Electric E.:Plumbing ❑Sprinklers D Generator L❑Roof Roof pitch
Total Sq.Ft of Construction: Sc.Ft.of First Floor:
Cost of Construction:$ 500 Utilities: Sewer El Septic Building Height:
nOWNER/LESSEE f s � CONTRACTORr �z f a=
Name Mgr rValAcc i Name: /KTld UR. £l\! e'L/vl }NM i
Address: 850 v1-1/41 'Frac-a.\ company:A ecom-r6 £i.Ec' ? 'o1 i CoAT,eneTiA/6, inIC.
City: 54-ca.c -- State: P( Address: 7/73 GvIlo1Tl PL-
Zip
4Zip Code: 34-(ctq LI Fax: City: POcr Sr LvCIE. State: a.
Phone No. Zip Code: 3475a Fax:
E-Mail: Phone No. 77 370-5755
Fill in fee simple Title Holder on next page(if different E-mail:Accu r'E ELeCTif IC PSL uriaOK%,Carl
from the Owner listed above) State or County license: EC0303070.
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
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iSUPPLEENTAICONS�RUCTIO LIEN tmli INFORMATION ' -,4* , ,k,- i � `.;?r -- .
a:
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: i
City: City:
Zip: Phone: Zip: Phone:
1
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. I
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 I
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 ith lender or an attorney before
comment work or rec.!, ding your Notice of Commencement.
4,07 /
Sig ure of Own• /Lessee/Contractor as Agent for Owner Signture of Co reactor/License Holder
STATE OF FL.RIDA • STATE OF FLORIDA `
COUNTY OF .. r l d c�.c.,L- COUNTY OF h,eaze.A.4
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The forgoing instrum t was ck wledged before me The far oing intro ent a owledged be •re me
this l}day of ,� ..g7 r:ert-t 20 f'by this /, day of r(9- r, ,24 .,by
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Name of person making statement Name of person ma ng statement
Personally Known , OR Produced Identification Personally Known OR.Produced Identification
Type of Identification Type of Identification
Produced Produced
., r
�, • i>>1iu+ii+iiiru/1
00-4.e... .e,( f,"(LAG t p1111�iy1 /�LGrz{�C' / 4se.c..,,,,, -fi
(Signature of NotaryPublic-Stat of Flo ' C.Vl �r`j/! (Signature of Notary Publi�of F ci �.•'` •i*w'` •.O 'moi
•`_°•''\5$Itrit' .O �4 + .eiER 2sg, :.
Commission No. .G SER �, :� Commission No. Or.*i.+. AWS . +_ *• • E
* : r•• :•7k2 y�••o #GG 137107 iy;
00.-. 0,
REVIEWS FRONT ZO '$� ° 5 PLANS VEGETATION SEA TU4..0
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COUNTER REV! Ail' •:° 1J6 ���`' REVIEW REVIEW REVIEW /Jlt4t iilll�i
DATE '3,�h11C.ST
Altt'`1`�,\
RECEIVED
DATE
COMPLETED
Rev.8/2/17