HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �— �{��'I Permit Number: I l Oy. O 0. 1
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Building Permit Application
Planning and Development Services
'Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �P,,I c
-PROPOSED IMPROVEMENT LOCATI IN
Address: 2 qf7 N I SUVA fTNe — .R�•
Legal Description:
Property Tax ID#: /�I'�s?�'a� rA — — Lot No.
Site Plan Name: Block No.
I
Project Name:
i Setbacks Front Back: Right Side: Left Side:
.DETAILED DESCRIPTION'OF WORK a
2z/0 ' D-f y'h � h S a IJ"�iDG G iIee
w ea, lk a-�eS•
"CONSTRUCTION INFORMATION
I itiona wor to e e orme un er this permit—c ec a appy:
,l
HVAC 0 Gas Tank Gas Piping Shutters Q Windows/Doors
I
0 Electric -Plumbing []Sprinklers Generator Roof Roof pitch
i
(Total Sq. Ft of Construction: S Ft.of First Floor:
i
Cost of Construction:$ Utilities: Sewer O Septic Building Height:
OWNER/LESS.EE CONTRACTOR.
4 j Name J/U /e n Afic,o%: ! Name: I'�i c•"h—c e �/_ Lc,�c / ,rte
(Address: n'74nev" `? Company::L+'I0,6,yQA1oti ��1dG�IhQ
_.
City: pS.G,r-v- State: - Address: P� - D�c /2 -7-5-7
Zip Code:3L/q Fax: City: ��- �r ed'� State: L
Phone No.f gLl3 lv`/D—/S�6'7I Zip Code:J3Fax:
E-Mail:CAl i (1,,I:1S Phone No. 2f2-- SI moi— % ion
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
St.1PPLEMENTAL CON5TRUCi"ICtN LIEN LAIN tN��RiVIAT[O'�1 � � �� � � � � � ��
�=yl.s Ky.t
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 o another non-residential use
WARNING TO NER:Your failure to Record a Notice of Commencement ay esult in your paying twice for
improveme o your property. A Notice of Commencement must b eco ded and posted on the jobsite
before the I t inspection. If you intend to obtain financing, consul it ender or an attorney before
commen work or c rdin our-Notice of Commencement.
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,�,e,4
Sig afure Lessee/C tactor as Agent for Owner g ure of C tactor en a Holder
ATE OF FLORI A STATE F FLORID
COUNTYOF I I_UCJQ__ COUNTY Q
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this q —day of 00a((JA .20a by 'this U4L day of -(fl_ ,,20�_Ot by
Name of person maki g statement Name of person making state ent
Personally Known )!C —OR Produced Identification Personally Known C OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signa ure of Nota ublic-State if F�4,Ii'Y► ) KRISTY SEXTONJ
to e o No ary Pu'Ai
State
N Notary Public-State of ^
Commission#GG 208 1'�Y a� KRI$TY SEXTON
Commission No. ' ;� �I). fission No. L /'• � lD ry
,ar ,. y Comm.Expires Apr 1 t tr 'M to Public-State of to a
Bonded through National Nota Commission#GG 208 4
My Comm.Expires Apr 1;, 22
Bonded through National Notai sn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17