HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: JI - . 1 Permit Number: ( 10 - 0 530
RECEIVED
COUNTY E
OCT 2 4?079
Building Permit Application Perrnittin
Planning and Development Services St' Lu /e e�p6n Ment
ep
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'IMPROVEM ENT-LOCATION,,_-.
Address: �v3 �` lt),311z-
Legal Description: h-c-ra P-C-e13 te- Z lc.* \S
Property Tax ID#: 3 - Lot No. V5
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'64 i`csv
CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all,hati apply:
HVAC _Gas Tank Gas Piping Shutters n Windows/Doors
Electric ❑ Plumbing I J Sprinklers _Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 7--1-4003.CDU Utilities: _Sewer I I Septic Building Height:
OWNER/LESSEE: : CONTRACTOR:
Name CAG.J`C-kc.)\cam Name: C.�f \'‘cx S
Address: Com' c k 4 1L Com- Company:"TT LvcNkle_ ks 1 tNQ
State::4=k Address: ZCZ 'S 'YT.d,/\- c cs Zip Code:Code: 7c-[ Fax: City: -c-c t "c State: 41-
Phone No. .N-1-7---3‘12--- -icX � Zip Code: 3k9`L Fax:
E-Mail: Phone No. 712 - I l 9 - 1333
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C_PC. (1-(57 8q
If value of construction is$25,00 or more,a RECORDED Notice of Commencement is required.
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.3. ,.: • ..�wz,SUPPLEMENTALCONSTRUCTION IEN LAW INFORMATIQN t { ,yfi
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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 j,..
before the first inspection. If you intend to obtain financing, consult with lender or an attorney bef• e „ -
commencing work or recording your Notice f ccn=:a.ncement.
7.! //g________„_ N dN / =l.L N
W S QLL�Y
'yam �� WAN m /`� `� z
Signature of Owner/Lessee/Contractor as Agent fo (� r.� Signature o' Contractor/License Holder ' 151-1'64
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STATE OF FLORIDA m STATE OF FLORIDA , Q 0a
COUNTY OF � .g.,/,&e.44, � ¢ z COUNTY OF j • �w �
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The forgoing instrument�-Awas acknowledged fore e mw m The fo oing instrument was acknowledged befor:,' * ` =
this /C day of 6.�` )- „,20 f lby t:,,, this /day of O C 4- ,20/$-by o"= a
' , .;k,• Q
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific.-:- Type of Ide 'fi at'on � �����
Produced < • Q ,L. Produced air• � C _
Ile
01) i i PO. V7L/71:10400r
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(Signature of No ii, Public-State of Florida) (Signature of Notary iflic-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