HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
e- -
COUNTY
v. u w I o n
Permit Number:
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
Address: 4;Q C) ( bU rfl+
if\
Legal Description: �4N rl Pre -3 SID-
t-, = - 1 -41 L -)\ I
Residential
I J -
Property Tax ID #: 1_J13 - 50a — C05 r (Y_)0 1
Site Plan Name:
nom10 1p�d
./ /�
Project Name: ry 1l �v
kpm til v e
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Residential X
►n�1�41 34l,_P' &P 4' UaCk Jinyl C.I-ain \',nk
a-nd A r ,)o 5' (,�O!k 00 -k -
Electric
Plumbing
Generator
Lot No.
Block No.
windows/Doors
0 Roof = Roof pitch
Total Sq. Ft of Construction: ScFt. of First Floor:
Cost of Construction: $ � F55 LV Utilities:Sewer D Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name I (\
Name:
1
Address_40l I trr-1+
City: 1--i-- PiP-iCtP State: FL,
Zip Code: ;3aQ6(/� Fax:
Phone No. `1iai-Q_1C1 - UIJn a I
n
Company: Hpf-pp—
Address: 11* l -x"'
City: � D D 0 �D o �L
State:
Zip Code:, `1 Q Fax: -1 CO�J
Phone No. `WOO _ Wa - t5 1-7
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: I I )1 i e. o(Jrr)Y?�,A_ Lal c)n
State or County License: 175q __7 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: �L Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 thepermit 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature o Co�or/License Holder
STATE
OUNTOYOFORIDA�Pc�P.
COUNTY OFORIDA(:!)Y-Q-Q C�Tihe
The for ing instrument was acknowledged before me
this ��dayofC_Q2-iC)Qe f . 20��by
The for ing instr met as acknowledge fore me
this• 20,ff by
day of �/�`-�r(1
n
1 `l � tt. -,0 ��(il.-JSC� J
�P�^r^
1 3 J� "T"� .
Name of person making statement
Name of person making statement
Personally Known _ OR Produced Identification
Personally Known _V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced/
`//\/\\\\`�` 1Q.r J�orf a
(Signature ofRosary Public -State of Florida)
(�
—��I,AYA_.l c
(Signature otary Public- State of Florida )
Commission No. geal)ULIESNELL
,f•`; N tary blit-Slatca(FluriJa
Commission No. Cl �prrr:" Seal JULIESNELL
�'•` Notary Public -5t, roof FluriJ,
' CommissionAGC, 195+1//
ui
"'"••+,,, ,,irr' My Comm. Expires Marl 3, 2022
Commmiun lIGG 19SN22
My Comm. Expires Mnr 13.202
un
ZONING
SUPERVISOR
ANGROVE
REVIEWS
FRONT
PLANS
VEGETATION
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
10A63E 63-6255 (772) 562-W22 (663) 38(5-4493 (56 )P144-1303 ,(172) 283-4540 (561) 9249 (172) 4653890
JOB NAME: /"«i Ierr DATE:
JOB ADDRESS: i1�0 8 u in -I- ire G'if CONTACT: L�
:4, �,°�yG� Fa! PHONE:
MAILING ADDRESS: MOB E:!�
I"N
EMAIL ADDRESS: /iAJe Q — 4r -W ® Allfl I ear" JOB #: DRIB 1 R lNa (2 Z Z
DIRECTIONS:
PERMIT #:
STYLE FENCE
POOL CODES
HEIGHT FOOTAGEyo��
HEIGHT � FOOTAGE I
LINE POST _/ `P -^E '
TERMINALPOST 7 y4; '
TOP/BRACE/BOTTOM
�j
TENSION WIRE QQ' .4
K
BARBED WIRE I1�d79L�i i
WALK GATE Z SIZE r FRAME
1�'grwldgd
WALK GATE _SIZE ,FRAME CONC-TE
I iI
WALK GATEPOST 2
DRIVE
GATE _ SIZE _ FRAME
CONCRETE
DRIVE GATEPOST 1 e
-- DRN'E
GATE _ SIZE _ FRAME
CONCRETE
DRIVE GATE POST
CORE DRILL/ASPHALT YES
PROP.LINES CLEARED NO
YES
PROP. MARKS VISIBLE D No
SPECIAL INSTRUCTIONS
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CUSPMER APPROVAL 4-rW 1 MA q
COST �� G , "DEPOSIT /0 5 (5. BALANCE 71 (O GS. cs
TERMS -
THIS PRICE EFFECTIVE UNTIL !6-4-09
PERSONNEL I irdM`5
INSTALLER
DATE
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