HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I /.
Date: 2-2-c - I qi Permit Number: 1' d1b 0L0.
COtANTY F` F
F Y4QA I -D bey V 9 CI
Building Permit Application ''��;� //74
Planning and Development Services `r�ee94�0 ,� i
Building and Code Regulation Division
CO 1.,6'���� '
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �/
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line -Y9 Ce,;
PROPOSED IMPROVEMENT LOCATION . -
Address: '7 C23 Alcyd' ii 7/ fv'J A. Pt 6.6--ce F- f q57
Legal Description:
Property Tax ID#: /,3Q i. 667 0 33 / WOO 9 Lot No.
Site Plan Name: 1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-DETAILED DESCRIPTION OF.WORI<
V5 l ( 2. 6c ' Q 6 ' IIi ) ii or
-ecce w) - (3 ) t wa- (k 94.1es
CONSTRUCTION INFORMATION
Additional work to be erformed under this permit-check all ;} apply:
HVAC Gas Tank fGas Piping I Shutters Q Windows/Doors
Electric 0 Plumbing l Sprinklers Ii Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2.'/9 Oa 0°' n
Utilities: I (Sewer 0Septic Building Height:
OUN:ER/.LESSEECONTACTOR , . ¢ -
Name Seri- /fe., i' Name PI r cI t te-( ik.) cict . 0 ,
Address: e76 0: N rJe-,F i ,g/Fd /. Co`mpany: .. 11IO.tveik6-A av1/ 1
City: ....j=F-z / el-fr'C, l State: :,::: Address:' .P" .,Qty" 12_7 5, __
Zip Code: '34 3c I Fax: City:. �-F- Pler State: i�e.-
Phone No. '712.- &lig - ( 2_47 cP Zip Code: 3E11 5 Fax: .
E-Mail: Phone No. —I-2Z- 5(`i q(0d'
Fill in fee simple Title Holder on next page (if different E-Mail:1A1 Wet (_xvloe i.y7dk)L4t r coA4Y GA 749. CO rA
from the Owner listed above) State or County License: O &C- t S f Ilia
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
L
SU 1 PL MEPTAL CONSTRUCTION LIEN LAw INFORl4ATIO> I
` .,. ,-.-.> , te,..',-` .: `S.t r v4 - + i - . tetgi- { •. r Y z i4
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,s imming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO •., NER:Your failure to Record a Notice of Commencement may (ult in your paying twice for
improvemen :to your property. A Notice of Commencement must be rect r ed and posted on the jobsite _
before the f. st inspection. If you intend to obtain financing, consult wit -nder or an attorney before
commenc' g worker r ording your Notice of Commencement.
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Sig .ture of 0;4r!'.-ssee/Contracto' Agent for Owner Signat,/ .f Contrac•ori ense Ho
S ATE OF J 'IDA STAA/_OF_FL0 ` Is
COUNTY OF C •UDC,l Q COUNTY OF \- t,)C•tib
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this@.Pclay of -. cu3J L) ,20 R by this 1St day of cl.1L-iIClifZ,{ ,20\C. by
( C\.iC .Q k —A . , _C)M..0 Mi i uaid Foo
Name of person making statemait Name of person making statemint -
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of ldentificati n Type of Identification -
Produced �� Produced
�- /
0 N -
s-c-- (ii,,,,,
(Signa ur- of Nctar OF •lic-State at re a Wit:. Public-State of Flo 'da_)__ _ _ _ ,_ 4
oai " KRISTY SEXTON 0 r'i�'••., KRISTY SEXTON
Commission No. Ij►lotary Public-StaG 0 FI Ida o h Nota Public-State of:lorida
aLICI 1om fission No. ��,. '�-
Commission p GG 20®3 i' I�'��
Atn. 44 L
My Comm.Expires Apr t',2022 � cR�'` My Comm Expires pssion#GG'1� 2022
Bonded through National We y Assn,
Bonded through National N)ta-y Assn. ll
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED -
. DATE
COMPLETED
Rev.8/2/17