HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v1 Y/)
Date: 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:
Address:
Legal Description:
Property Tax ID#: .3` Q-2 — 60-7 — b I q D cid �g Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF
C bN 1�EC 11 I'�C� ,y d TE 2 Q N.L.
Additional work to be--p—erformed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric 2Wumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
Name L. Li Name:
Name:
Address: 5q 16 SI Lac(- nK 1712• Company:
City:.L+, PlE2Ce State: ( Address:
Zip Code:-IE�34.%2 Fax: City: State:
Phone No.95-4-3�5—(7y q- Zip Code: Fax:
E-Mail: TSGKITC� *&,0 L_ •CO F-1 Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
WMETTIAWITNIFURRIATION:
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
commencing work or recording our Notice of Commencement.
S' a Ow Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STAfEE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'F�_�_ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this i.2—day of ?.(_) J , 20_�&by this T day of 20_ by
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Name of person making statement. t Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L)L. Produced
(Signature of—Notary—Public-State o orida ) _ (Signature of Notary Public-State of Florida )
a_
Commission No. (Seal) „�.° Commission No. (Seal)
orn
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REVIEWS FRONT ZONING S Its PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW aM REVIEW REVIEW REVIEW REVIEW
DATE Qt." , a'
00 coo C
RECEIVED c�
DATE
COMPLETED N N C
ev. 8/2/17
St. Lucie County - PCIS ST.LUCIE COUNTY UTILITIES-P.O.BOX 728 FT.PIERCE FL 34982
I
11-06-2018 12:14:43 NAME ,C,f
18213/5155 ACCT.#
CUCCHIARA, JEFFREY SERVICE ADDRESS ` C
5915 SILVER OAK DR 0
FORT PIERCE
FL 34982j �.,....
SUBDIVISION
__j-.
Amount Tendered: 519.00 LOT—_ _BLOCK
I J
Amount Paid: 519.00 BILLINGADDRESS I
IChange Due: 0.00 Ccs
PHONE#_ ( J �'' 3a Oji 1 j rf
Thank You Y—MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewa
I services to the premises described above ' nce ge dis osal
with the User ID: RODRIGUEZM rules and regulations,which by reference are made a part of this contract.tApplicapresentnt agrees etrates,
pay
the Utility promptly for such services in accordance with the established rules and regulations.
I CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. �
SOCIAL SE /
FED ID
SPOUSE SOCIAL SEC.
DATE RECEIVED „i,( CASH OFFICE USE ONLX
CHK# RECEIVED BY