HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��//-�,
Date: �1�?-1 11$ Permit Number: gd 'acto
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION `, _ � ' ' "< {�
Address: LI$(o0 Wctlr- "Sova 7
Legal Description:
Property Tax ID#: g53 6 pp--00(RO- 000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK 1 xis t
rbtry
CONSTRUCTION{INFORMATION k z `
Additional work to be ertormed under this permit—check all-ARA apply:
El HVAC Gas Tank ❑Gas Piping 1 Shutters [1 Windows/Doors
SElectric D Plumbing El Sprinklers ID Generator ❑Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 5o G Utilities:b Sewer DI Septic Building Height:
SOWN R/LESSEECONTRALTO _x
r
Name Ukcorc iLo k &\t.-/ Name: &17-/US lGc,'ggLN1/Nd
Address: 551% 0�,,-� LS1r Company:AetdRJ7 EICCIrefeicri CON-RACING) JAR.
City: Ovr1.0v, e10 State:it Address: 7173 Gil[1oiii Pi-
Zip Code: 32 VI et Fax: City: PoR.r ST 4,ticiE State: FZ
Phone No. Zip Code: 3 15T Fax:
E-Mail: Phone No. 7702 370-.5-755
Fill in fee simple Title Holder on next page(if different E-Mail:ACCORIfie ELECTRIC PSC coo-wog,PQM
from the Owner listed above) State or County License: ECCOO 307a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1
SUPPLEMENTALONSTRUCTIONLIENLAWINFORMATION. ; , `
, , i : f ,
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 i=spection. If ou intend to obtain financing,consult with lender or an attorney before
commencin: _. k or record* our Notice of Commencement.
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Signature` .wner/ ssee/Contractor as Agent for Owner Signature of Cont • 'or/License Holder
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STATE OF FLORID STATE OF FLORID c � ,
COUNTY OF COUNTY OF /
The forgoing instru i-nt wa ac if•wledged be re me The for Ding instru ;nt wa ac,owledged before me
this day of -' 1 / 20/ this of . 4r ,m. 20Wby
724•Zjit-4,-4 frt--e.../.--"" / n
Name of person maKng statement Name of person making/Statement
Personally Known A Qed Identification Personally Known "N.._OR Produced Identification
Type of Identification Type of Identification
Produc \1w1Nillini , Produced
e�1 R;....�!�f eeji� 40111i111Nfip
.. �. oy'.�/y04� ,„,e9 - ^ 1 EC.yiR fir/4,
(Signature of Notary Publi - ati elf florin a L tl, = (Signature of Notary PubliAtat f F •.rt• 1AR ?'�"•. 1
= •• :*_ ; .4'4x, tq'; ..
s 2:2 #GG 137107 ;; .*w
Commission No. �„a.►:64(4yal) @4.:Q. Commission No. —_*.; � 107
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TUWT44j,lllloom OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
-
DATE
COMPLETED
Rev.8/2/17
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