HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFMU BE COMPLETED FOR APPLICATION TO BE ACCEPTED Number: U - DS S 1`1
Date: li- ac8\-
C -r y
F LR t i7 14.
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 TYPE:
'PR®'POSED C1 '°OVEM 'OCATIONB " `
Address: J 305 `off' C)ifx<1 . -
Property Tax ID#: 3L*e - (Q(b(1-.0 I hl l- 0 / / Lot No.
Site Plan Name: Block No.
Project Name:
SAILED DESCRlPTI®GIrW®RK° p ;^
Tn—A,`1 LA_),-Netr rv�ce_ - i a-- Cf. h Lia
•
i .
CONSTRUCTIONINF®R A .ION '•! Awa£
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric ./15-lumbing Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost.of Construction:$ / 500 _ dL Utilities:.'=Sewer° _Septic . - Building Height:
:®WNNER/LESSEE? ":A. = ¢ , ;CONTRACTOR
Name Name:` , Yl ' (3Jhe5
Address: 5365.. t oef Cdklrc 'N. Company: j�, '(\ems dimbi h
City: 51- Lcverai ( State: -F.I Address: %Cod 5e"J Gronc;\ Re Mi/e ll�
Zip Code: 3 k' a. Fax: City: -p(5- State: F-1)
Phone No. 95'% - 31.4 (, Zip Code: TS Fax:
E-Mail: Phone No_ / 4r,' '7(06 �p,z_59
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License CE---[ 5 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
I
5UPPLEiVIE1\iTAL''CONSTRUCTION3LIM tAW II 1F-®IRNMATI0N I
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable ry�
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 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 your Notice of Commencement.
•
Signature • Owner/ essee/Contractor as Agent for Owner Si:na• re o Contra 'iglicense Holder ,
STATE OF FLORIDA STATE OF FLORIDA,--1.A.
COUNTY OF 5TW�ze • COUNTY OF ND i/(Q ,
The for oing instrument was cknowledged before me The forgoing instrument was acknowledged before me
this 9 K day of /VOW ,20/,(11 by this 2Kday of /VP?) ,20 JP by
• 7(57,11e5 • V'vizu , viD 5 .
Name of person making statement. Name of person making statement.
Personally Known OR Produced Ide '; •• nally Known OR Produced Identification \/
Type of Iden Ji#ifia tion // r KIVELY OPIZO Type .f Identifi . 'on .
Produced t /L! 49 !41 ' '' -'0G Notary Public,State of FIopfigd ced Ii j, - IVELY OPIZC
A
Commission#GG 261056 / 4, _ otary•ubllc,State of FI Nide
11611
^ My comm.expires Oct.9,2022 / ' x „ C• mission#GG 261(t6
// OA rr 111") ,•comm.expires Oct.9,. 22
(Signature of N''tary P.blic-Sta • of Florida) (Signature of Nota PubI -Sta - of lorida)
Commission No. OCi7-t,q.r>0a)' (Seal) Commission No. terc f01--.)_ (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
3ev. 9/26/18