HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number: lgos'Qc��
Building Permit.Application
Planning and Development Services
Building and Code Regulation Division
230U 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
15k�,a^t,e r rH'n�' r6 at->fl y^xe
Si14t 1is.:�"u#:.,aa,.aI,P.t.(?,„,.i.-va:ya i.x.)e�•:_.�i I{:'w'a t�I,.,Q�n:..�a . s fit{'§".A,: r, aaM it x,ta6a-!4',ii iti Na:?ryU'�n1t:},�„{lt.x!'S3�:,y;r,_�'�t"+J,:P.d 9 1�;t.r:{}f;i a€F6t'<ud,.�itjq�n{i.,.�4}SXn3.i i+ii-,"rqIatYt,i{�d"i.�lti..'1.'1..{4*.'F,i�4.J9 n..F,"s.ra_ iha,�t,,l,`,4k.d.�,{i}_ a.,;�J'R��•+�F.e.ri 1 i Sa�ivt ir'�.:',,};i<t�i9"n'r.v'°�..;t,S..an,�•t,.'.t-�:tr7}ttt.-rs3r!tl(!'iil:,,{�r�'..i'��;. i
3i4£ttrR 4a, 07
A i-kUaT:fdqii,:
1/s it.t ,I4 . t 1193iili.S iIt. ,r„..< a•:.ld i,
Address: _ lAVEn U2
Legal Description: C _+erS I) 0,93AL CO►z �q ,G
Property Tax ID#: a„9 C)5-1 a _Qmzy - C= Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i a MIN
�I I dill , ` �rro” �'^�Ai!M1.0Ia r r 4& Y ..�r
�e ever i ze, ��wz� On
INN
yat.:sz-1i. "rtii^ti 'li,ti1?ai�I� ib �.!'.
%Si' t, I• ,Y:'4 �S ,i�i i I t 1 1 t"'� 'i� �� � i�!t It t �`iSa�, i`i `4fi, I Jz 7xi t Y
rl
��.. i 1.. `� S �'!}f,. ,�-Y41'
t, s}.,E 1 ,.`x{t tr ,i ll 4 j ; r�Yyt.i•11 S!,`YT ra lIf33' iz"@I iF S? r5 !µ
r14i�1S4i +--_,}i.iu, llll,a
itiona wor to a er orme under this permit-check all Jiat appy:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ c�CO
l 60 Utilities:11Sewer Septic Building Height:
is t '! +! ? e t im i r'i F' a: l ih }.,..!• r i�y n.t E 4i ! l' t'. S c . 4 2
1•}�{.t;�{��^"r�l II� �ti.'i i r� i�.. (�}rr,�i)r�;.f{ ,f�l�� �j I ��i r;t"3't�a l ,yti;'s.�.,+y.,-�r",� d�lil4,' r iJ i_l��1 . ,t}
i�" �rCA. sQR kris °' I r �?x ra•
1 a
,fa},2. �t{z.s,;s. ! i,�r�,..�.>?�a�li.4 r, l�k.�,.,�4�t,,..>j,i•il'3 � i I a.,..r,i.,!i ,t�`� E , t1 �,..:�tl.a�ll�r.i a r4�:?a harts r� .ri r. {�,1�e'1.t?rii,.lrr�i, .n�'+��'*�',Y�s�,-,��1 ";.�1 I'll?,t��,-�
Name �6UR6E Ar1d FF M II_�f �►� o Name: OnmeS L , Ho t�.la
Address: r�03�(�- �U� 'lih. I�VE . Company: 1�Qiula 1021 Y'LI
City: M i AtA I State: Address: IOIO W a H IdL bt j
Zip Code: 'J3I LoG^aq1Xn Fax: City: State:F1
Phone No. So I- ff)1a-3?)Lq Zip Code: 2LUa- Fax:
E-Mail: Phone No.
Fill in feesimple Title Holder on next page(if different E-Mail: jnesUhl.wren
from the'Owner listed above) State or County License: �P_e1?'10��01-�3
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
( a•,p' te. 41A{ i" ( jACk i7! Y i"+ ]�"
e ff�
"+{� ! )"'9l 5'Lf
I I K �!,' • 'NHI 11 1 �3 iia( t3�i li INNALAffill
fWI t,;xtl
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
I Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
C FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
e
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
c
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.
Signature Owner/Lessee/Contra for as Agent for Owner Signa t f Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFS-�';�_, u�, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
th!K ;day of I�Aon r20by this day of()�,Q Ao 2011 by
Name f person making statement Namk of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
, r
(Signa ure of Notary Public-Sta of Florida) (Signature of Notary Public-Stat&W Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT. ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17