HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED&APPLICATION TO BE ACCEPTED •
Date: I I-I 1 1 Permit Number: (2 I I D..3
(0 Ii
C LI 11\117
F L D R I 0 11
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:
. PR®PQSED f. 1PaROVE ._= LOCATI®, a=. . . . 1 :' . , . ,4, . .
Address: . , s 6 - ' e D C A L , ,.
Legal Description:
Property Tax ID#: 6 'CI '550-- (Y02(0_ 000 Ul Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
bOAIRXD5 DESCRIPTION. WORK?' ' . 1:'".4- . °;t . l' . ; $o. .
z CO/r " ,swX 63•_ro 5/ - •c
giz 2f- 5--7-/ A--- 0A7F. z/V,27/")477.529 sem//w*z
CONSTRUCTt 1 NFODMATI®No ,, e°- ''
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors{
Electric _Plumbing _Sprinklers —Generator Roof /g'Pitch
Total Sq. Ft of Construction: '....5‘ j Q0Abl Sq. Ft. of First Floor:
i
Cost of Construction:$ /6:) Ove Utilities: _Sewer _Septic Building Height: /3
DINNER/L`E=SSSEE6 ° a ' $@NTRTACTOR°
Name/GG- /v/`(G f' 5 % JQ/ 77 Name: 01tD OA) Pi,9'
Address:cP 6-cG Tlvl. cd LAItr. company_,GN/0 AA.)„02/lJ�r7L fUlb72)%
City: State Z Address/3'600X ,P ill 7
Zip Code: ?9' 9?3 Fax: City: / .S7, ,f State:
Phone No. 7.72_- 7c 5 Q- % 3c dL Zip Code: 3 9�Er. Fax:
E-Mail: Phone No 7 7i.- cFO) ',5 K
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed abl.ve) State or County License C C C 217/ tit.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
1
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SUPPLEMENTAL CONSTRUCTION ,a1 LAW IN:FORMATION:.:
DESIGNER/ENGINEER: 7R--lot Applicable. MORTGAGE COMPANY: V Not Applicable
Name: Name:
Address: i Address:
City: I State: City: State:
Zip: _ Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: fiit 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 yo r Notice of Commencement.
...j7.....7__, _
_AlliY ' - .
Sign. Owner/Lessee/Contracto as Agent for Owner Sig -- of Contractor/License Holde,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 7C)/j S J L U�/� COUNTY OF i' T S7 4-- ' /
The forgoing instrument was acknowledged before me The forgping instrument was acknowledged before me
this/6- day of „teal ?z/3 , 20/g"by this%d day of /\i ?gelZ, , 20/TEV
A/4/y /1Dec, P"Li '1 (---)--4
Name of person m king statement Name of perso aking statement
Personally Known OR Produced Identification pL' Personally Known VOR Produced Identification Pe,
Type of Identification Type of Identification
Produt:d Prod aced
i AIP
(Sig . ure of e�tay,a•;!,_„,Sta iLgli APOMTE _ ur-J No ,�; :c �.' � a •
i �CPONTE
�I'= MY COMMIS:ON#FF962064 Commission No. : -.•�: MY COMMISS Fa�p62064
Commission �,' ea ) /
EXPIRES F ruary 17,.2020 .,w„`, EXPIRES Februiryel7,2020
i4C7,3.1.5t"53 FbridallotarySwliic..carr• 4C7�399-0;53 FlariO,aHoury$wvrr.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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