HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '�
Date: Permit Number: 1.3 03 _
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Planning and Development Services St. Luce Coin ment
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 X
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ,I
PERMIT APPLICATION FOR:
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.PROPOSED INPR®VE EfT L®CAT1QNo .° ..
Address: L) OCt\aOAdt L ULGt t 1:1-. P‘eiILQ, ,F1_ 41ificl
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Legal Description:
Property Tax ID it Ir 1 )— rip" OO7'00019 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
J YET1A'LOD I C'RIPTION. W®D K° $:
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CONSTRUCTIO .INF o R ,,TIONo ' , ti ,.
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: -y, V-i- Sq. Ft. of First Floor:
Cost of Construction: $ oa iD Utilities: _Sewer Septic Building Height:
® NER/L&-SS5E).. .°, r 9+., v. '. !r; .CONTRASIVR° '`• b * f.:". .
Name - 6Ca1'\ OCC Name:
Address: 6N-to Oci\U, e d LOY-1- Gtr(',.- Company:
City: 7-A-, ?te(CR ! State: FL Address: - - - ii
Zip Code: 3'-( l Fax: City: State: I
Phone No. 7 77? (o Zip Code: Fax:
E-Mail: l'e kctlnc 2i'�Icej k0o.ccon Phone No
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.
S APPLE j ACMIST° UtT RIMLAW ' .KAIMATIONo:
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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �c— Lfi.A COUNTY OF
The forgoing instrumentw�a acknowledgeyJ�before me The forgoing instrument was acknowledged before me
this '\*day of Mils—,4ls—, ,20 ) by this day of ,20_ by
(10
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio ./ �/ Type of Identification
Produced V Produced
(Signature of Notary Pub!' ' • — (Signature of Notary Public-State of Florida)
1pµYPVe% ELLEN VAUGHN
tee o_Stat of Florida-Notary Public
* ""' *_ F y ommission No. (Seal)
Commission Na ��e,. CobWkion #GG 270079
My Commission Expires
October 22 2022._
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 8/2/17