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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I(JJii /Wig Permit Number: 1610. 03(o COUNTY ' L O • D • - 1 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 k Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: Gd?SFO S Oceah Dr. JeinSen Beach , FG. 34859 0(.0i144A/9 Legal Description: Property Tax ID#: q 51 (^ SQ) - 0.00(- 0 OOi' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: 4?Q/vioV 0/64;1v,) V3M,+' Cie-Ms f aid ivvotall p©cd¢ ' Per_ipcie- c Y (441 �1 gyp,( - V lu�� fcio`� l 0.2 l 2� J( -CONSTRUCTION INFORMATION: . Additional work to be ertormed under this permit-check all apply: HVAC II Gas Tank nGas Piping _Shutters ❑Windows/Doors IEElectric ❑Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$ 3 0 0. "12 Utilities:Sewer 0 Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name VI$ 11)//1 a D eve.lopmen4 1.7D OA). S V O Name: 0 MI 1. R. biETILIV A Pc be . Address: 5 001 Sc)V) Ma V-CO ex Company: M 63712,6 1-;1.6=c-ret C S g-(ZV 1 C6;1g6. City: 0 w lando State: F{-. Address: I.5 0 S 0 Nb' ton-) Ali PNUc Zip Code: 32.1. 1c, Fax: City: Ni 1 A-H I State: Phone No. Zip Code: 33 I $I Fax: '321 %250-n14 E-Mail: Phone No. 4'04 7-38 - q/5it Fill in fee simple Title Holder on next page(if different E-Mail: elm el- 2 . %9a en e rg y i M C 4 gpia i 1.crrM from the Owner listed above) State or County License: tC/3005316 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: r DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable' Name: Name: Address: Address: r 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 commen ing work or record*gieour Notice of Commencement d1114414 NIMftL Sig --re of Owner/Lessee/Contra"as Agent for Owner Sign. . afa�r�e^ ractor/License Holder STATE OF COUNTY OF FLORIDA � STATE OF FLORIDA ne�(.. COUNTY OF The forgoing instrumen wa acknowledge efore me The forgoing instrument as acknowledged before me this I( day of Ot ,20 br by this ( t day of ( ,20 If A by _ anA Ir ( i r 4ifi Name of person making state-Wt Name of person making statemeYlt Personally Known OR Produced Identification V Personally Known OR Produced Identification V. 1' Type of Iden ificati-oQn l, ` �� Type of Identification n Produced tibila. .. ( C e.11),� al� Produced Q✓I�„ Iapari�r�rfA f lovL l:Vtr j • (Signature of N.I ry Public-State o .FI i' GEORGI A ELIZABETH C a ire of Nott Public-Stat o •,or a J a + . -� o Notary Public-State of F n %,,,,,,AY 1•f/�,�•.. GEORGINA ELIZABETH CANAL I •. tl���• Commission#GG 124400 /19, sr'.` \.1$% Notary Public-State ofFloiid Commission No.( la�'I I .% `:,a, ``5;, MyComm.ExpiresNo%1Gd071mi Psion No. °c ' . I'C , !Seal)Commission#GG124400 Bonded through National Notary Assn. %;4:,ter. J. My Comm.Expires Nov 11,202 0 Bonded through National Notary Cs • 4 _ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17