HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 10III IZOI t PermitNumber: I1fl'1X .O(D
COUNTY i -i
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 Y Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED'IMPROVEMENT LOCATION: gs
Address: l 0 4 I/0 S d c eVI b r. 9 e 17 S e�, 6P ado k . 2 y . 3 ,BLP C5'
Legal Description:
Property Tax ID#: 1-15I I —6Q1-00-01- 0001 R Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFWORK:.
hem 0 ve Eit 4- o Y vu/ Go-1h tcl ,-,v3-43# pod 04- reoty'lalda
p- beck rvti'(9r G u L cQl -p_ 7/! f Co f ,)or ( it 6011602,40,31601/7
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all;J apply:
LIHVAC I1 Gas Tank nGas Piping __Shutters [1 Windows Doors
Electric ❑Plumbing ❑Sprinklers 0 Generator 111Roof _, Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1,$ `vS30 O. '° Utilities: I I Sewer Septic Building Height:
OWNER/LESSEE:, CONTRACTOR:
Name Vi)efall . bavdO?W/ O L7.) % SCO Name: om412 I2 . 14L2A/Ak1II62
Address: q0 0.2 S�-v, /In SCO 0.,r Company: i ma e L€CTfZ/C sci /CE livt.
City: 0 r 1 .0L-0 State: rL_ Address: 15 c S 0 Ali V TM! I I lig
Zip Code: 3 241 9 ,Fax: City: 1 itiVM/ State:
Phone No. Zip Code: 3 3 1 k' Fax: 22)-25O -1S1/74 I
E-Mail: 1Phone No. WO - 73:- gf S
Fill in fee simple Title Holder on next page(if different E-Mail: OM Pit- e . 19a Here)y in C.d 5f 3-.I,esPA
from the Owner listed above) State or County License: e G I 00 531.6
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 , 1
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 recor•'ng your Notice of Commencement. /
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Signg1114P'l r•er • • ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA J(ce0 r 0- COUNTY OFSTATE OF ORIDA 0de0^10-COUNTY -
OF W 1c-�C✓
The forgoing instrument was acknowledged before me The forgoing instru ent was�acknowledged before me
06.010e.this 1l day of 06.010 ( ,20 i' by this ( 1 day of E k?YC ,20 t9 by
0 w1.o.r .0Q( ran cLuOievu .cr e 0417
Name of person making statemenV / Name of person making statement
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification �n1_ Type of Identificatiogin- A
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Produced *1t?i(l&A .�.caev\k►f.iC4++,,�h Wv� Produced (101/1 J (df&ccc al eel'r1S
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(Signature of N.,1=ry Public-Stateof,Flil1',i 7) GEORGINAEUZABETHCANAl� = ature r( Notary Public aQ� IpridAdpRGINAELIZABETH CANALES
o` _ S f%'= Notary Public-State of Florida
a, . ,: Notary Public-State ofFlarida r� , ,_ I
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• I Commission `1115SIOn No. '"'1 ,-� � �S�q
Commission No. ( pl ° j ,1,71 -,fl`�oMm.ExpiresNov11,2021
!%.:5....,„+� v"i My Comm.Expires Nov 11,2021 �r� y
f�;' n r` Bonded throughNationalNolaryAssn.
'.�;;,!:�•• Bonded through National NolaryAssn. / .��""""��
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17