HomeMy WebLinkAboutBuilding Permit Applicaiton 02/26/2019 08:25 AM PST TO: 17724621578 FROM:5617631006 Page: ,2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 r tcl Permit Number: lei
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: g /7 1 O?MPSQY t PON *
Legal Description: t OVV V)JO V\ 9O t P k PO 0 1G VI -2 I &
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Property Tax ID#: a /
011-002 5 - 000- Lot No. t 4
Site Plan Name: Block No.
Project Name: -
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all Ihaj app y:
UHVACas Tank Gas Piping I I Shutters fl Windows/Doors
Electric IJ Plumbing riSprinkiers Generator l !Roof- Roof pitchl
Total Sq.Ft of Construction: S Ft.of First Floor:
/).15 .0
r ,
Cost of Construction:$ trrfi. ( .Utilities'I _Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ��NvveS �� Name: S h0QG? 611401'
Address: 5,F11 'ow\ Qc i Company: bmoi-l- It 1C
City: 0Q' �� a . ' State: Address: c //9( muJ 'i o h j ,.
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Zip Code: `16' :Fax: City: PO - ' 1u '.- State: FL
Phone No. Zip Code:3)1€ (% Fax:
E-Mail: Phone No. 5- P73 t'/2 q
Fill in fee simple Title Holder on next page(if different E-Mail: -eLt.e 12 I1 t YAG P hVV.. cow
from the Owner listed above) State or County License: bre ( (.)l day
_
If value of construction is$2500'or more,a RECORDED Notice of Commencement is required.
I
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02/26/2019 08:35 AM PST T3: l7724G21578 FROM:5617831006 Page: . l
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ___NotAppUcabh� yN���T���E��y09��� ___NotApp/�ab|e '
Name: Name:
Address: Address: ,
| City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ��A��� \
Name: ' Name:
Address: Address:
City: City:
Phone: Phone:
Zip: Zip: e:
—
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit
toduthewurk and installation as
indicated.{certifymat nowoh,orinataUatinnhascommmncedprio,tntheissvanceofapermit
k representationthatthepermit build the5ub� �
uur '\
St. �
! which is in conflict with any applicable Home Owners Association rules,bylaws or
and covenibit 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 thiested permit,I do hereby agree that I willin all respects,perfhnnthevmrk
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.ANmticeofComn�noenentnustberecordedandpostedonthe'mb
site !
before the first inspection. If youinte d to obtain financing, consult with lender or an attorney before
recording Notice of Commencement. !
�m~ .
� AP~
Signature of Ow :I./Lessee/Contractor as i!gent for Owner Signature of Contractr/mce
STATE OF FLORID /// ' STATE OF FLORIDA c:::: /�-
COQNTY OF -_�' / ��w ��[ [OQ0TY OF / °
acknowledgeddbeme Them
this �� � � 20/v)by this The~� ' / /
7x�/� ' /
' ^/`° �V�{�� � �__� ^��/o2^r-~--" ' _-~' f7./-
--- Name of person ma ng statement Name of pe
Personally Known , OR Produced Identification Personally Known /— OR Produced Identification
Type pfidentifi�atio� Type of}dentifica�u
' Produced ^ ~
Produced , �
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_ Erik' ^ I� ( '^��' » N»� • ^ '
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Commission No. � emoga
Commission No. �
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8OAU���A�mn�dow `w��o� |
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE |
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED _ _ _______ _ _____- - _____ _
MATE /
COMPLETED _
Rev.8/2/17
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