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HomeMy WebLinkAboutBuilding Permit Applicaiton • All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 12-161- Permit Number: 11011 - 0�� t' 1 co- 'ix',ave 4, Building Permit Application / Planning and Development Services ervtti0 4/3?Building and Code Regulation Division ' •Zo Ocyc, epa 2300 Virginia Avenue,Fort Pierce FL 34982 Com r�j0,21, Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential PERMIT APPLICATION FOR: PROPOSED`I 'RROVE1M�ENT Le' ATIO - ' : , ,, ''W k . Address: 5540 St, l(jtoi-- gW D • Fog,' O - " 7. 3 1 Legal Description: 30 -WC Yo 6 0 3/ �a SO) 1 of' 4j ,`f -c.Z�i A 562/9 0E1 boy? 0 y e l' /in. j g31 , F�c.11-- c /I L/t/ .,4 333 F efr7SGfi (otz -32?-7tD Property Tax ID#: 10.0 - 331 -- 7 7.--O0:0/5Lot No. /1 .---11/ Site Plan Name: P-00D gUI V J EZ "MA tie't 6—&-cO 27 _ Block No. Project Name: Setbacks Front bo0 1 Back: 17 Right Side: / Left Side: /0 itS AILS© DESS` R PTIO,N: `Y ORK �£ , , ° • ' ' • . : . ., . ._ _- `� .--,f•,- til, i'Wd, e1 x e/ Dc/4 57-fD Pr'e9'a446-rccit 2-x9 C-eliu 2'f' fr(an( 1-ePcce / Z114 &9 ds 1 rrn-60. ( slack FETI EI CTYON NFO.°I A X10: . , ~ . Additional work to be performed under this permit–check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors —Electric —Plumbing _Sprinklers —Generator _Roof; Pitch Total Sq. Ft of Construction: CJ y 4:i -F (--- Sq. Ft.of First Floor: _ Cost of Construction:$ P2. /1.00'400 Utilities: Sewer _Septic Building Height: 0, '!NiEJR/LE_SSEE°, ' '', - ' ffO:NT' CTO'R: Name . h 2't!i7n #41'1. -1-. Name: Willie Address: 55010 B/VD " Company: OA COI4iE fes ` , City:_ 'rp a fJ'/ 7- _ State: j✓� Address:. 33 ( 31-H.--15P 71.-- ii Code. i ° t� Fax . 2 i/^O9t Cit .1. P1 °`n om-mac State:F1--- Phor)e,No." _77Z. , X6 C7 Zip Code 1N: •Fax cf6p$(o6 •`7 X17/ 1 a21: (Cf 77e E-Mai_, SY.�. ..tel,.... _. GSohone.latc =x. _ _ Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed aboyl e) State or County License e75c_P-5sCygo-- I ! I If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 1 b.. ivform N AL;CONStEtUC�T�-ION LIEr•LAW INFQR F a41, .° 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 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.ycitz, /Lt. � / c,� iJC- --c-K-'--r Signature of Owner/-.'Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA ' STATE OF FLORIDA (II COUNTY OF 0 ill-e/C4!. COUNTY OF ' V The forgoing instrument was acknowledgedjoefore me The forgoing instrument was acknowledgchoefore me this 7 day of TdK. , 20 ( ' by this "7 day of ,,car-cam- , 20 by (Name of person ackn• • ledgi•; (Name of perso• acknowl:•ting)� �m. p 4111/4-111111WAr allrA4111%, 4111 if a IP A2 (Signat ota • " St• - of Florida) Trtu - of N 4 . 1.7.1b' -State o o.':a ) Personally Known V OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced ,l Commission NoF/,9c� r`� (Seal) Commission NoF-/9&5r-`, (Seal) REVIEWS FRONT ' :Zq�l,lr J' `�: PLANS VEGETATIOFJ� ([,5 144.1 TA. ►�46'y, r• COUNTER..:•'. ':1•71A. REw s �►! � REVIEW REVIEW •,�'E _ +'1 : DATE !!!*!!,;;,. 41.4oz,s03-0153 flo,derbaarS.,,b,.wm RECEIVED DATE COMPLETED ev. •