HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLI/sABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat/ 1 Z 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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IME DEMENT LOCATION:
Address: 3 SO 9 /�.c 5 e C �,,. ✓1 b l v ✓- t ✓ -1; e; r t 6
Legal Description: S; A �j il e
Property Tax ID N: zuz$' 762E 00 12--67nU - 2 Lot No. /2
Site Plan Name: l;",; 5 e O en e 5;1-s Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AA ")e OW
2 .5 1m^ -F-,, - 5 k, Ae,, f
CONSTRUCTION INFORMATION:
Toy
Name cPv,, 1A e r
Additional wor to be e
HVAC fiGas
orme un ert
is permit-checka
❑Gas
appy:
Shutters
❑Windows/Doors
City: Ca-+' Qi PrcF S[ate:F e
Zip Code: 3 V 0 92- Fax:
Phone No. 7 7 Z" 2 D�
Address:: 2✓O/ +/. /-Fi7.,�
Tank
Piping
_In
E -Mail:
❑Electric ❑Plumbing
❑Sprinklers
❑Generator
❑Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction:$ 3�r 6 0,
0-19 Utilities:
❑
Sewer
❑Septic
Building Height
OWNER/LESSEE:
CONTRACTOR:
Name cPv,, 1A e r
Name: roo K e e
Address: 350$ ROS e �r,-n 9/v C(
Company: e, eS
p
City: Ca-+' Qi PrcF S[ate:F e
Zip Code: 3 V 0 92- Fax:
Phone No. 7 7 Z" 2 D�
Address:: 2✓O/ +/. /-Fi7.,�
x/06
City: o ^ a ^'O _
Zip Code: 3 0 6 5 Fax:
Phone No. ftr% r
State: C L
E -Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E -Mail: 6 a 2 ei f -1-11 o , LD
a A o
State or County License: ei *I /P o
G L
If value of construction is $2500 or more, a RECORDED Notice or Commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
The fo oing instrument wa acknowledgeVefore me
this / day of f)<� .201^ by
Address:
Name of person r9aking statement
City:
Zip: Phone
State:
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
SUPERVISOR
Address:
VEGETATION SEA TURTLE
City:
City:
REVIEW
Zip: Phone:
REVIEW
Zip: Phone:
REVIEW
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 Counttyy makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conFlict with any applicable Home Owners Association rules, bylaws or an 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.
Inconsideration 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
commencine work or recordine vour Notice of Commencement.
Rev. 3/2/17
Signature of Owner essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDASTATE
COUNTY OF �t E WR. r pG
OF FLORIDA
COUNTY OF gR""�`' r(
The for going instruii��entwa acknowledge�,before me
this /2 day-. OG�o �w ,20;5 by
The fo oing instrument wa acknowledgeVefore me
this / day of f)<� .201^ by
Name of person making statement
Name of person r9aking statement
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification _
Type of Identifl tion
Produced Z— i�
Type of Identification
Produced
(Sign re of Notary Public-
C. 6. 07se +wsWu1waeuuwouin
Commission No. ^: At♦%f TXggg93IDNk 0007
EXPIRES Ms" 01, 704
irature of Notary P r' a
W b.0"/ oaa wvss
78 mission No. MY
76
EXPIRES Memh 01.7021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 3/2/17