HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 111 a II& 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 Commercia
PERMIT APPLICATION FOR: Plumbing
Residential
I.PROPOSED IMPROVEMENT LOCATION:
Address: 10
Legal Description: eo9-pesVNpy-ezim
Lot 113 N1^
Property Tax ID #: 233-2-7' -% (� " �� (A JlJ - 1 Lot No. 1 G
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Block No.
tol w -1c, So gco l or-) -e k-eQ+,r' C waica I n
9"e.
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit- c—heck all apply:
HVAC Gas Tank F]Gas Piping _ Shutters Windows/Doors
11 Electric L� I Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
SFt. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address:
City: 191: • �} . LG1 i 4F State: EL-
Zip Code: 349 b (p Fax:
Phone No.�1w1Z •Z- C)
Name: R�JQYY1.� n
Company:, )Qrl(\\YlIf-CLU$
Address: ws' w2m�
x jf„y p, J
City: F+ . p
Zip Code: 3q,5 Slit Fax:
Phone No. `772 - $in ` 29(y2
State: P41
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail:
State or County License: Com'
Jr IMUS h1b� r+�
11 vaiuc ui cunsuucuun is ;)zDuu or more, a KtLUK1Jtu Notice OT commencement is required.
►t^
LIEN LAW INFORMATION:
SUPPLEMENTAL CONSTRU��l
DESIGNER/ENGINEER: NoApplicable MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: Address:
City: State: City:
Zip: Phone State:
Zip: Phone:
EE SIMPLE TITLE HOLDER: Y Not Applicable
ame:
[Address:
BONDING COMPANY: Not Applicable
Name:
Address:
ity:
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.
FSignatur,er/ Lessee/Contractor as Agent for Owner Signature f C or/License Holder
RIDA STATE OF FLORIDA
COUNTY OF_ 6- 1 C'
COUNTY OF S�f- , L�C�-4Zr
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisgdayof NC /Prn13QY
,20-& by this��.^day of. NL)V?MiXli 20 1% by
5e-rn Q m� h ;:5i hre r1�
Name of person making statement Name of person making statement
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature Notary Pu is r"tifi4 e of Not Public- State o
Commission No.��sr0 P1ctryPubHcState Floridad' F n iie Tatiana Pe m i s o n N o. �7 OV C% �,vxr a I rotary Pubk State d
My C,timmfssion GG 024960 Angle Tatiana
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N Per
F x,' irrs 08/25/2020
My Commission GG
4 0
or n Expires 08/25/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
8/2/17