HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUS(---\ __T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 19 Permit Number: 17°10-3! tf-75g
,C L.NI T Y ` �� MAR ®'1010
F L o R a rs Pi -',:. Ctnit
----. - Building Permit Applicatwa9DePart
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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 I/
PERMIT APPLICATION FOR:
PRO°@SED E1NPROVEM LOCATION A,•.. ,.
Address: 76 76, 64(0,1 /f uc-1 Par'f" 54, Lac,e / F-L 1 Lf 7f Z
Legal Description:
Property Tax ID#: '3/4 IL-1 ' F(;11 — 1 M9— atoll Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks- Front Back: 1 0 1 Right Side: Left Side:_ )4 0
DEITAILEO D tSCRIPTION'I WORK° .: . o -
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r// 74 7dfr X V,c-' CA1S1 hi) ^I[ , .� 7L� 4 i 4 . gei /L ` N-30 / S/ads rale,- C�,rlil%_s.
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Co® STRUCTION.IN�FORMATIONo '' 3
Additional work to be performe. under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric �,_ '`" -.-Plum(rbing.;..._ ,,r,,,��.,_Sprinklers —Generator —Roof Pitch
Total Sq, Ft of Constructio : ,''�2/jct,`y 1't-; , ,i Sq. Ft. of First Floor:
�x 14 f•t� r l':::.::::,..',;...:3'
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Cost of Construction $ $ Z/1 O Q®..', :;, Utilities: _Sewer`- - Septic • Buiidirig°Height:
OWN£R/LE--StiSEE - a CONTR i CT®R° . °�,r,n :S.:'.1'
A,� : i1r ' f
Name 1)QUid tv1�(,vs-�er�pp� '� Name. .' ache Ovc.t�+l ,,',-,:'''-,,..',0,: ::'',._ 1
Address1(d1(e) �� ,-k &a Company: Two La;iier Cc-,n/:i-ne71;it:/ IA( '
City: (- la'r�wC\'� Stater-- Address: /09 f f Henrys: Q
Zip Code: 35c31 Fax: City: Pt. P;rrc e State: FL
Phone No. Zip Code: 3yy 4.t' Fax:
E-Mail: Phone No 77Z- - Z/p - 5-c14
Fill in fee simple Title Holder on next page(if different E-Mail -f-cdr-bo 9ZG e ycihca, Ccs
from the Owner listed above) State or County License CBG iZI-907`/
1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
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SUPPLEMEN AL CONSTRUCT®Gl[ aG1.1NFORNIATIQN
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, co It with lender or an attorney before
commencing work or recording your Notice of Commencers nt.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDkTh
COUNTY OF v� LUCA COUNTY OF Luc.r
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 8*- day of ('V a e•-h , 20 (`i, by this 1 'day of V-\O-rC_ ,20\\ by
Lane. c-auic L14 NE .DV -wd� f D 1, 3of 2ks�3;-1 (ad
Name of person making statement Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known I • __ - 0- ication
Type of Identification Type o':. -4ati$h4pRAGORpON
Produced Produc • 1,, 41769 ,
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TV Expires f
r + P 11 • 7010
e'" 14" 71111111111111 ,
-ignature of .1r6n0lan 1012022) Signature of Notary P..lic-State of Florida)
MThwTr y?*I9NWinne1dOd86.7919
Commission N.. - - -a " --- • Commission No. (Seal) '
REVIEWS FRONT ZONING _ SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 8/2/17