HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1.7113115I
113Jf5 Permit Number: WI( — 'Deg‘\
maINNIEWNENA
COUNTY.R D�L^ SFO
F_L O 1 D A - 14`
Building Permit Application POP/17 . 28/8
Planning and Development Services oand Code Regulation Division et ee79 't
BuildingDient
Y
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential L .
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,PROPOSED IMPROVEMENT LOCATION: •
Address: aQ 3 ge/710 nil VC
Legal Description: RUhlrilon 5/P 131 Ic 7 Lois 9,16, 11,i4 Qfid w 1/2 o/ 14o/pohit of 6c
Ca g-/- i4I2roe) 5 (0176,k)COQ .fie'/7/e153;3797-aeso)
Property Tax ID#: 3 L/C3 -80 s-Qlaq -000-7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF
• WORK:
•
-�ns1ail q� U/4ie 1/mv1 p c4e/ An? � �a�lh side o�
pr6p�fr<j
Deco4 ' OW
,Z15 CF
CONSTRUCTION INFORMATION
Additional work to be erformed under this permit-check all apply:
HVAC I1 Gas Tank nGas Piping I 1 Shutters El Windows/Doors
ElElectric 0 Plumbing li Sprinklers 0 Generator 0 Roof Roof pitch
1
Total Sq. Ft of Construction: S Ft.of First Floor:
.
OZ
Cost of Construction:$ 2OO Utilities: I Sewer El Septic Building Height:
OWNER/LESSE��E: . 'CONTRACTOR:_
1p
Name ` /��'/1i1. /hie Z C Name: 1•vlr) kw g n
Address: l93 f On i Company: r cur' M ETM or? ale O
City: le400State: FL Address: 7/ 0 M ' C
ir
Zip Code: 3313 g Fax: City: F . "'erre State: FC
Phone No. Zip Code: 3g4(/S Fax:
E-Mail: Phone N.. '77.2., o - .5t1a6
Fill in fee simple Title Holder on next page(if different E-Mail: rtOSUr' "# f' 0 ` • 1 ddh
from the Owner listed above) State or County License: ^/5c L/e2
Ali
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTALCONSTRUCTION'LIEN LAW.INFORMATION: _
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: . Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
I 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 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.
C__,p..., A.k.
CLks. ige_i__,L.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 - L... t COUNTY OF 'j 1 . I.0 r { t
The forgoing instr ent was acknowledged before me The forgoing instr�U1ent was acknowledged before me
this! .lir'--day of � c ems," ,. — ,201 t by this 13 qday of I Jecr :"._ti zr ,20 12 by
ame of person making statementName of person making statement
Personally Known OR Produced Identification v/ Personally Known OR Produced Identification L---"V-
Type of Identification Type of Identification
Produced .1_.--- Produced 0
Cile 1
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
I
Commission No. I'l
C. )-o �1g mg,04,,,,•
COLLEEN:St r iffik'itw"r o. Vr 9_O-1 7)D (Seal)
i• •_ Comn,rssron N FF 209728 ,,�rr'Z,,, COLLEEN SUE HAYES
��iiiiro My Commrsc,on Expuos .a'°�o,.,
''•,°nu„t _ / �_ co,,,,,,,,,nn i IF 909778 ,
Murch 1 S, 2419 `,/''�� -
wiii,►r My Con,nussion Expires
REVIEWS FRONT , ZONING SUPERVISOR ' , S EGETATIOTURTIidEirch MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ItLVICW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
I
I
1