HomeMy WebLinkAboutBuilding Permit Application ,
•
1 i I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat : t/ 'c7-1,- )a
Permit Number: 121 I--D los
..Coot_i FAT Y ,
Building Permit Application
Plan ing and Development Services
Building and Code Regulation Di,Vision ,
2301Virginia Avenue,Fort Pierce FL 349821
Pho e:(772)462-1553 Fax: (772)462-1578
I Commercial i... ----- Residential
PERIVIIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
i
Ar5RntLIMPR69010:01. LOCATION:
Addr ss: 33 0 aI L":"---r\ rec-ek-`,..5.e ad .
Legal ,)escription:
e
1
I
Property Tax ID#:aLicia- 5-6a--c.5z: 3 K- cco-(0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
1
I-'•I'L...'it::4111tAfigOtiti.:0APANioaK::.:
5 ee c--- F t t L-J , A`•c, \,,, A w-
'21
civ oc.5k. Cebyl,),e 45--, .,>7•. 5,00%.,v,J
,cio NOkbettpimaN FORMATION -
ite, e—,...14-Ikb,.. ' '..,-- 4 '''i. .. -' .- - • •'>.---“-: : •7 '-''.. ;.:
Addit anal work to be ArtorMed under this permit-check all-JA apply:
OHVAC L„,4 Gas Tank EIGas Piping .. ...Shutters 0 Windows/Doors
0 Electric 0 Plumbing Sprinklers U Generator 0 Roof Roof pitch
—I I
Total Sq. Ft of Construction: S . Ft.of First Floor:
I ..-. -2<-"..
Cost of Construction:$ 1 -../c.-) / ...,/ Utilities: Sewer C Septic Building Height:
t,.4.tt..,.e...& , CONTRAc.lo.. v.
Name Al.,.... U(%0-5 I E-A-1-e,ciac ' ‘'..5 A Name: Alo54.--, C.,"3 , ,--1 TN i
Addrt:336 a ,c-i.,\A-c rec ,5c. (6.A. /
Company: ("Jcz. 131- Aar' coytc_t.4',-,..0-. ‘1
A *7
City: , . 1-el(.(e State: ' Address:3?15)1---- CD/e?c,,i-cAer tr,--c.
Zip Cede:, Li 9 c-64).,1 ! Fax: City: PA . le',-.0)cc-4_ State:
Phan- No. ! Zip Code: 3 Li 5 5-...1.. Fax:
E-Ma I: I Phone No.
Fill
Fill in fee simple Title HOlder on next page(if different E-Mail: i•-•"-k)1 .-c--s'-c oric-i .s--Vte-, P( e1/57)J-I, .v1-j
1 '
from the Owner listed above) State or County License:CA-a tat 3ce 5-(
1 i
If valu of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1
1 '
I '
I 1;
1
.SU PLEMENTAL.CONSTRUCTION LIEN LAW INFORMATION': - -
,
DES GNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Na e: Name:
Address: I Address:
City I State: City: State:
Zip: Phone Zip: Phone:
1
FEE IMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address: I
City: 1 City:
Zip: Phone: Zip: Phone:
I
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. I
St.Luc e County makes no representation that is granting a permit will authorize the permit holder to build thesubject structure
which s in conflisu
ct with ar,y applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
struct re.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In con ideration of the grpInting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in acc rdance 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,
access ry structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WAR ING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for 1
imprc#vements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend toobtain financing, consult with lender or an attorney before
comrtiencing work or recording your Notice of Commencement.
` /
I �
Sig a of Owner/Les ee/Contractor as Agent for Owner Signa 1.D�' oT Contractor/License Holder
STA E OF FLORIDA I STATE OF FLORIDA
CO NTY OF - ot,...c , --L COUNTY OF ••_i
I
The fprgoing instrument{was acknowledged before me The forgoing instrument was pcknowledged before me
this 1 0 day of A.leoi,,c wt �-a 201 K by this l Co day of AJ veva ,,f— ,201�Sby
NameJJJe of person making statement Name of person making statement
Persnally Known L.1*- OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod ced Produced
/{'fit Ay ._ , A. ,,. .,
-w-N—, . -J-- = ` MIKE MARTIN
Si nature of NotaryPu is-, MIKE MARTIN t'��'='�o`%
( g S ipf,Florida) kSignature of Notary Public- :-r•-'l•,_ -,atiotary Public-State of Fiorta
. ?*�,.1+•'s Notary Public-State of Florida ( ;.s ,.:l y Commission#FF 216951
Commission No. 1 o•• ,.•; .•e fission#FF 216951 ;� �'� roc Ig�rA�mm.Expires Apr 5,2C 9
commission No. ,, .
•%';�� P:; My Comm.Expires Apr 5,2019 Vi,
'••;�oFF�d:� ������•• Bonded throughNatlonalNotaryA;En.
•,u,,,,,• Bonded through National Notary Assn. v w e s�
I
REVIEWS FRONT .' ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
RECEIVED
DATE
CO PLETED j
Rev.812/17
I f