HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'1a,� 1 `� Permit Number:
RECEIVE[
Building Permit Applicati n FEB 2 8 ,�`�
Planning and Development Services ST. Wei@ 0.. W SEi�f�tli�
Building and Code Regulation Division -- --__
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED,IIMPROVEMENT�LOCATI�ON:, /
Address: 1 .5-22 W LJ Bu-4c),i b u S h Circe'-e P001;'I
Property Tax ID#: �� �� a ('o `6 /S– O()7� --OC)O– Lot No.
Site Plan Name: Block No.
Project Name: /--I' A r b oo rf;� :d q-e,
DETAIED.DESCRIPTION"OF WORK.. '..
Rernyoe �een d t`ef�lace (1 (a X '7 (r�rq e Doo r
CONSTRUCTION INFORMATION:
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: Sq. Ft.of First Floor:
Cost of Construction:$ /y SY Utilities: —Sewer —Septic Building Height:
O.V1/NER/LESSEE " <, CONTRACTOR:_
Name W ,1 1.�G r A4n c-:5ka 1-1 Name: 1Ja I I a 5 I l e
Address: /_5, a AIW rc,J:2 Company: CUeckeao{ Door cvFftieTreersu.c
City: pc;G Iyr, C t l!�! State: fl- Address: 3 9 5.1 )S'sCa. I C1
Zip Code: 3`1'q CIO Fax: City: R ;u�'ec-a O ea LA State:fL
Phone No. `17).- 3LIb - a8,?g Zip Code: 3304 Fax:S�l'g8/-917o3
E-Mail: /&,Nar5ku 11fL03114m a> G 1na;I .Co"*"' Phone No Sr- I- S9s/-g ')oo
Fill in fee simple Title Holder on next page(if different E-Mail C 6J i J SC>1 60Z��er)e4 Jeno:fc .c o/'1
from the Owner listed above) State or County License C13 C )2591 401
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
E
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 our Notice of Commencement.
1
Signatur of Owner/Lessee/Contractor as Agent for Owner Signatur f Contractor/License Holder
STATE OF FLORIDAn STATE OF FLORIDA
COUNTY OF Ya I vm 13ea ch COUNTY OF �a)M f�)ea.c h
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9�7_day of .Fe 1oTua r--t_ 20 P by this a5' day of Feb rua.r i ,20 1q by
)a.1 l aS /A ;d L-er Qct 114 S AA v l e r
Name of person making statement Name of person making statement
Personally Known L_— OR Produced Identification Personally Known t--- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Stat of Florida) (Signature of Notary Public-State of Florida)
CATHLEEN TRACY WILSON t CATHLEEN TRACY WILSON
Commission No. NOTARYPI(1 M0 Commis , NOTARY PUBLIC (Seal)
STATE OF FLORIDA o -ESTATE OF FLORIDA
Comm#FF915846 Comm#FF915846
Expires; s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17