HomeMy WebLinkAboutBuilding Permit Applicaiton ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE.ACCEPTED
Date:. '3ra Permit.Number:
-
COUNTY
F 1. O R & D A
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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:.
Address: Cn 7 7 O J/.Cie/ 00Y PFS ./P6L775%Lucz
Legal Description: OLr I-` O -Pr 8L_6CLQ 3 Lo T
Property Tax ID#: 44/S 7O 4 064/?-000 Lot No. "4,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: 1, Left Side:
DETAILED DESCRIPTION OF WORK:
c620 U l Sr
�Pr N(Ht _
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit-check all ply:
HVAC II Gas Tank nGas Piping12_1 Shutters ID Windows/Doors
ElElectric 0 Plumbing 11 Sprinklers E Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ 71: ac; Utilities: Sewer.,Septic Building Height:
OWNER/LESSEE: __ . :_.; CONTRACTOR:
Name 1O/L11/4/44 T- 17,42Vi(y Name: 72,,-;-4 coitc Lurk L-rcrbrvO
Address: .,7 76 /)/GKzit/ /if r/ Company: 772 J, eaar ,4-.Lv L#vv('i-PeAO
City: Po"?' L_v e-t State: Address: .rte-w2i F4-L,Y
Zip Code: �zteq<12 Fax: City: T962!s-rLoce . State:. L
Phone No.pg."? 22.24/--7'41S3 Zip Code: . 4rRS.2 Fax: sa6:3"3 .,5'
E-Mail: /LS&(.A/1 6ptP(L..COM .Phone No. 77-2 2¢(—
Fill in fee simple Title Holder on next page(if different E-Mail: .,c'2 '. /pGA-r e L,C_am
from the Owner listed above) - .State or County License: 2.4¢22
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 your Notice of Commencement.
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Signature of Owner/Le ee/Contractor as Agent forth Ael/ ' Si ature of Contra License Holder
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STATE OF FLORID'j r R. m� ;. STATE OF FLORIDA' 1 Z m �
COUNTY OF �j! • 24 268= '': COUNTY OF ._40, P: .,. . �'.p.
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The forgoing instru ent was acknowledged before '' kc a' ` The forgoing instrument was acknowledged before g-41 11
this_ 7f Ct 20L by ` this / t) day of a&f ,201�by• : I o V r
a -T-V ?
'��(. / "_ `jam"Cal n i A-C. $ ,
1, CO�
Name of person m king statement N Name of person making statement
Personally Known OR Produced Identificatioi, _ _„_. Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
h
(Signature of Notie Public-State of Florida )P (Signature of Nota ublic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR . PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW , REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
Rev:8/2/17 ,