HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ei lLCI I Permit Number: (SO1- OiW"1
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esegew; Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Fierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential -)K
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 1-15-70 5 Ocm... \ w
Legal Description:
Property Tax ID#: 952'3 - i't3'CI 005010--,, . Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.'''-'r',•-':Fi;•Y;c;=',z-..-_,-;',:c-tOF .iwoRKSPfAVv,-;4-,;.p...-4 ,6'i-‘,--,:fre..At
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CONSTRUCTION -*ATIPNN-,.00-i:n'.v,tvgd-VV-A;:Va'PV3:K4i3,'1:3ZiojPUP,5iiSkSA:V;4iii,NA
AcilitiOnaiWork‘tO'be erformed underthisl'ierriiifC-hecic all L 'thIj apply: - - - - - - - -- —
EIHVAC Gas Tank JGas Piping J Shutters 0 Windows/Doors
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law lectric 0 Plumbing 0 Sprinklers I:Generator El Roof Roof pitch
Total Sq.Ft of Construction: Sopki of First Floor:
Cost of Construction:$ 500 Utilities:l: 1 Sewer£11SepticBuilding Height: i
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OWNER/LESSEE: -. a",;:- ,,:=LL. :;5"A'..: =:=:,"2"..2':;':'C'GNRRAQTOR:;.1;-i'*k4NNV,?.'fil,'SrOAL;4V?;;'z-:-*'44.PeA:iS
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NameCpc.ack-Zaly,". Lat,di c krS ;;;;;;:AgrtitIg. C-11/4•166L1v)AAW
Address: -2.-7 7-0 'Sc.4.) I I-7 IA Avt Company:A ectheitrg 66c-J-kica-1 Com7zneriivG, JAR_
City: rJA.vi c State: el- Address: 71 73 GUlluiri P-
Zip
Code: 33 Va,c) Fax: City: Per Sr Ldere. State: FL.
Phone No. Zip Code: 3Lic15Ta Fax:
E-Mail: Phone No. 77r)-- 37O—. 7$5
Fill in fee simple Title Holder on next page(if different E-Mail:Accogffre et-CC:RCM PS(-Q.0 07-030g..Cori
from the Owner listed above) , State or County License: 6 C03030 7ca
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMETALCONSTRICTION-LIEN iAW INFO{ RMATION; < �� ` `�j`' J, , . -, E s,,
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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.
1
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 fire inspection. If you intend to obtain financing,consult with lender or an attorney before
commencin ork or r-•'.riling your Notice of Commencemeii
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Signa / der
e of Own 'z/Lessee/Contractor as Agent for Owner Signature of Con• .ctor/License Holder
STATE OF FL•RIDA STATE OF FLORID •
COUNTY OF COUNTY OF ,. off #.
The for ng instru "fri.);.:4vac wledged before me The for oing instru ent s a owledged before me
this i day of ,p0 -(,.201 y this l ,day ofllp�fji 4-t I-C,/,201 by
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Name of person makiatement Name of perso -•'aking statement
Personally Known /'\--OR duced Identification Personally Known.”------OR Produced Identification
Type of identification Type of Identification
Produce Produced
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C? C Gr ‘%\t�SE C.V1:11'0 f/i 9/4)442;J(7/ .•
(Signature of Notary Public-S atey �Flotit11*
crr k .• o ��— (Signature of Notary Public-Sr e of F`q SEC lit,-
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Commission No. *: (Seal) ' z Commission No. � • `�aER� •.0 s
„2•Z #GG 137107S 0. % . E.
*"la*Z 41424 inimilmillERT.-1
jf-34 ub/i lhientel�.. c," �� y.w-00 70j- ' ?R*�
REVIEWS FRONT Z• ''3{' .StA R PLANS VEGETATION SEA $ar ea ' *Vif.
COUNTER REVi ,t Niton M REVIEW REVIEW R �C .'•ma • v.�`•.
DATE 1li1!ll,n1TEO�\\\��
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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