HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: IR ra-0) -9
COUNTY
PLORIDA
gill/S11/11/211.01.- 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 X
PERMIT APPLICATION FOR: To-seteet-from_dfeaborefick-afrow_at_the_end_of_iine Qe_60 P
,PROPOSED IMPROVEMENT LOCATION
Address: E-urO feet Lc/./1e. Fr- ea;g Ft g 9 z
Legal Description: Pci fin Grave 5/0 WI' 6 Lo
Property Tax ID#: 1110-5-03 -01013 -000-/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK ' - -
'rear s1-145 C,9ies ciou),-) 4-6 Ply hioo (I) I1I y 1000 7L6 CO de
30-# Fe 1 r d.edct y/v/P41-1OwlcI614149-les appited Code,
CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all;hat apply:
EIHVAC Gas Tank riGas Piping Shutters I=1Windows/Doors
ElElectric 0 Plumbing Sprinklers Generator X Roof EMIll Roof pitch
Total Sq. Ft of Construction: 2.50 O Sq. Ft. of First Floor:
Cost of Construction:$ / 5T-61,OUtilities: Sewer Septic Building Height:
OWNER/LESSEE: : ; r,CONTRACTO .
Name Sok n 4-4 Aipl-o.n Name: Rs)to d Luje
Address: 36k, 't/iroper-.44 La A C Company: Skorevi-e_ nog,'
City: Re t- 'Orem e State:r--L Address: 1(1)3 Ci le? ede 57--
Zip Code: 3Lfq -z Fax: City: pit Saiv1+ L06 State:
,Phone No. -)1 _26-? --1-101 I Zip Code: 3(4q Fax:
E-Mail: 1FL 1(16 chivir_o5±1 /194-- Phone No. 77Z- 160- 95-6 5-
Fill in fee simple Title Holder on next page(if different E-Mail: ,5/10v )' /eroociAeYh0(,), (ô.4,7
from the Owner listed above) State or County License: CC.C-/3 3 I 1 )'D
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: __
City: State: City: State:
Zip: Phone Zip: Phone: 1 _
I
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 thea rovedplans,the Florida BuildingCodes and St.Lucie CountyAmendments.
PP
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.
)2j2k.
Signature of Owner/Lessee/Contractor as A ent for Owner Signature of Contractor/Lice„re of r
.
STATE OF FLORID STATE OF
COUNTY OF FLORIDALU C l . _ COUNTY OF �(,C/'e l., `
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this f' L day of ' lE'c ,20 (C----by this 1)--,day of JAec____ ,20 if by
6o\Gw) v0-1 Ro\c{v,0 Uol (e)i
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 t L_ pc_ Produced Ft 0 (_
(Signature g,[�' Sy Publi$ fL�($�AIFH ° (SignaturBalk.mw..._ ..71-
i0 ��-State of Florida-NotaryPublicon ublic
3* ” .= Commission #r GG noires
-4 i11'P°c My Commission GEx7 l)
0079 ,
Commissitti;1,i,,.oPc ?Ave1 Commissi n rf�°���
;evd°Dr My Commission E Aires "'' Ot„,j4 22, 2022
'iii1Plo October 22, 2022 - ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER ' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17