HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application RECEIVED
Planning and Development Services JAN 012-019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 T. Ydp Cwoty Perrnittina
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Res .
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PRQPOSED IMPROVEMENT LOCATION . „ ',r
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Address: 7•� 3� -�/ Sim A -e - -
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Legal Description: CV ftz G S J i7 f ty,i �,, GV�� Ky— .L155
Property Tax ID#: Li �,q>, —7 0 C l C) C)Dd - 9 Lot No. E3.
Site Plan Name: ' Block No.. LI S
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DES�FRIPTION OF WORK J kr wr$'`r ` ° ` � `t;5 `
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KCONSTRU�CTION INFO_ RMA_TION,•.. �..f".'� .�n�€.; kr�:`, ' ; w�; ,° ; ,� �...,- ,; 3 �ri_x ...__; .. .}'�.._.v4... - ,a�.,�.,�.�.'
_ditiona work toa Orme— --un--der this-permit—c} ec a app y
HVAC 0 Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Otlec tric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost.of Construction:$ 14 d• b c� Utilities. Sewer Septic Building Height:
OWNER/LESSEE �_ ; CONTRACTOR s RF s y r
Name a.7 33 aU P�VAUo.�LL C Y Name: CAAs P,Yee lzc,19
Address: Li be6'Gv YV, Ki ) 0-�I. Company: CyV'S+VL4-CRGh Co�i/,�
City: ^ T �e-C- State: R Address: 1\ ,G� I�i�5 1� I
Zip Code: 3�l q S�• Fax: City: a'• i� Stater
Phone No. 7-7a cl^7(~ d 13C. Zip Code: 3��r 5(- Fax:
E-Mail:: Phone No. '77,4-- ct 7Ci- 93 3,L.
Fill in fee simple Title Holder on next page(if different E-Mail: $PG6G L-id,t 6 (3yeSv C11
from the Owner listed.above) State or County License: C6C l SOq C-1 a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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"SUPPLEMENTAL CONSTRUCTION-LIEN-LAW-INFORMATI'GN,:
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 thepermit 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_reeording your Notice of Commencement.
Sr6fidre of Owner/Lessee/Contractor as Agent for Owner Sign—aRt�ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-3r, COUNTY OF 5.4-- Z-i,,ci r' .
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this -\ day of-�Sq y-\ .20 4 by this__a day of ;