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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / / Date: N 0-a GO- 1 r Permit Number: I el 0— (.0 L r COL' INT' Thr F L OR I Q iFk. 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 t. PERMIT APPLICATION FOR: PROPOS [7.I,s 'PROVEMENT LOCAT OtIg --#;m`.' . : ' °` Address: /O 7g 0 Ora mfe Al e I / f t//err e j / Z- 3 97 Legal Description: Property Tax ID#: 23(99'-/L'1/. 000/ - di t/ -!q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DCLAILED DESCRIPTION W WORKS::r . -3 . f' = !`ica( °u-IL�e 0 - ::': ? i,-, - • , et(p►q, ro,wir FRI_ , .C©; STRUCTIONe[ JF®RMATIONo .' s ,..: . a ' ° ,,...'$., Additional work to be performes under this permit–check all that apply: _Mec nical _Gas Tank _Gas Piping _Shutters , _Windows/Doors lectric _Plumbing _Sprinklers —Generator _Roof Pitch Total Sq. Ft of Construction: - Sq. Ft. of First Floor: v o Cost of Construction:$ j 75-37,— Utilities: _Sewer _Septic Building Height: OWNER/LES-SgE :. . . ,. . CONTRA a OR?... ' a Name Vie na,, - '17ar,n Name:Al/!"A/54 ''61 drr� G7147'roDors�1nc- Address: R9 c "0rQn e, ',Av' Company: Je7 T4,i41y$oA;`;:''" Cit . Pieu-c State: FL- Address: Gr d- - <; Zip Code: 3 Lf9%L5 Fax: City: t7;e4•c z State: Ft_ Phone No. 370 -t1 '/2 Zip Code: .31,494 7 Fax: 4r 4=,37 E-Mail: Phone No 77,2 371-53-70 Fill in fee simple Title Holder on next page(if different E-Mail a/lf"welt e YQ)i g0, c a ??..i. from the Owner listed above) State or County License i--r 000027,,Z5.-- If 00027 , ,5.--If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. UPPL M : CONSTRUCTION L EN.LAW I,N ORM/ o ar Q 4"` xn g-.�5� :,$"e i^' w,ge•> r .� p,..1 r, ;x .,,�„ ..".;fie€ ".."� .�"•n' " 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commen ing work or recording your Notice of Commencemei _' � --� � 1 , Signatu e i er/Lessee/Contractor as Agent for Owner Signa' 24.rfof onvactor Lic-• e Holder STATE OF FLORIDA �p STATE OF FLORIDA r COUNTY OF `�� '� 1V I COUNTY OF - \ �.)C,{ - The f$${{g�o�ing instru nt as acknowledg before me The arcing instr nt as acknowledg before me this d'l/day of ,20% by this day of , 201by ,.. .e_ vf, \ 140 nip f\ r rNi--The nApsot--1 , Name of n malting statement. Na of 'Mon m king statement. Personally Known . OR Produced Identification I Personally Known OR Produced Identification / Type of Identification Type of Identification '. Produced @ L, J L__. Produced 4 L. t, • cr''A.,/-0 ,` i _%. V-\...‘ ,(1 -------- ,, (Signature of k••----•-• - (Signature of NotaryPubl' -_ '...- .`•=LSEN ( g o•,�,pYPGB�� ` _ _NIELSEN i �-State of Florida•Notary Public ,,111,,, KAREN S. Commission Np,.* :_4 ._ Commission # X6119?484 Commission No. :oj.���,State of FI'�ii� °tart'Public ' �y� t rIZ p _ „ tSFi E SEN ,, My Commission Expires 1� Commis ''''r—f"•` June 12, 2022 -•7,,-ij ►o`er My Commission Expires ��111111�� _ 141:71,,,,47... I i�'gllllllli�0` • - . ; o. .: 12 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAT.0 i SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE • RECEIVED DATE . COMPLETED . ev.