HomeMy WebLinkAboutBuilding Permit Application , II
All APPLICABLE INFOjMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: l I ( ,/ Permit Number: 1q0("^ (fib- ,r
C 10 Lr i17Y
IF s_ ra F s ray el —
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 APPLICATION FOR:
`PR®P®SED INPR®VEM L® ATO H,
Address: 560 6 30‘, " 1J�r7 (-)(�'C4 �'P/� �� 3 yQlt� �'
/ ' 1
Legal Description: 'r
1
Property Tax ID It: 1,31 ' 5 os` -, 'C 000,L3 Lot No.
Site Plan Name: Block No.
Project Name: 11
Setbacks Front _ Back: Right Side: Left Side:
DETAILED DES"0RIPTIO WORK?' . ,. ; ° ° " 9 ',
J °.. i .9
tie l�� lPiLl 01 qi 6 �1� oucr G7`�4l4 01/411 S fie. .. , �! y1 1 ���d
�6 11 fJ /
✓T Jeer `6i 5 l;, , ( eve Gi`Lai eb 4 (5
I, 9 /6 ICU, 1
.CONSTRUCTION INF-OP MATIONo ,.;x. ,. - ...-''•;?,......: .
Additional work to be performed under this permit-check all that apply: 1
20 Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
—Electric _Plumbing _Sprinklers V _Generator —Roof Pitch
Total Sq'. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1,100 d Utilities: _Sewer _Septic Building.Height:
It
OWNER/ SrEEo' " y CONiTiR,A OAR:
Name / , inr 4.h �s Name:. Nod lor .5
/. 1 Jr
Address:' 'cc i b S(th J,' q' Company: So 1Plfs04 eofierh) tIJJ ' hie
City:' I'�'g •P� ( State: ,_ ,.,Address:` /r' MC (�/6,{
Zip Code: J i a Fax: r�//11 City: foçi Si-i7 `vel?*� Stattie:: rz
Phone No. , l0 r3l`S b(U z�/ . Zip Code: 2 Fax: 7 " Z'b-9/ao
E-Mail: soh exhAfet�f7 Phone NoO
Fill in fee simple Title Holder on next page(if different E-Mail - C6 TO i7V'C ( 8!(�/- 624,
from the Owner listed above) . State or County License C (f/ ?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
.SUPPLENERNSA STRUCT'IIDN �' n�`N IN @R�MAT Ole. . ' , . .
,. ..6E . , . ...
.
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
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.
_/r
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OF FLORIDA Woe COUNTY OF STATE OF FLORIDA 5/ r.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of <3((h ,20 19' by this — day of ----_a , 20 17by
NUM -10( ' • 't)\ 0 F[oreS
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification i./
Type of Identificati Type of Identificatio
Produced D L. Fc- Produced I)L_ FL
I ( +�, I%
Nina�dre of NotaryPublic- 4� e�•==
(Signature of Notary Publi State :f FJ�C'4 ) ELLEN VAUGH g �``� ELLE
a i �* State of Florida-NotaryPublic ���/�,,,P�e°- to Florida-Notary
f
�(�-� • °1'•. - Commission ;;E GG �[�- I^': S Nota�N 1
Commission No. ;a.; ,;.,.�I �i?;ion No, �!
i 7iijitfk.F fission # y Pubi
.;�F�; �o� ) My Commission expires -,� GG 27pd,
��"I October 22, 2022 ''#''"'°��`` My Commission g
erealiftwwwww..ww.gm.,„,,m,,,,mirmelimeornir -...10 Oct..= Expir6,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ' REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 8/2/17