HomeMy WebLinkAboutBulidng permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S v- 1 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2360 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
Address: I ,'A{(o
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK`.
nQw orio�Ja i re, 3 to 14 566P. C ?",& LM i t -
W l-tJA 1 D Kut � ea.
r+auii nai wort w ae enofineu
HVAC Gas Tank
uocuer uub
❑Gas
Penuu— 6aelR du
Piping
Name: 0
dpply:
Shutters
Q
Windows/Doors
i
city -A6 State:
Zip Code: 3 �t 1 J ( Fax: u li4
Phone No. 1-12,- 2-52- q 5 255
-Humid npyr�
Address: tl0 A (LIMDI�tP_ YPI/� rCA'
City: (k Rif it - I - State: 'Fi.
Zip Code: 34g5�t`1 Fax:
Phone No '7a- `n0 (—� (
E -Mail: N I N
"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: W P 'WAk o CD rl
—DD�P
State or County License: k( 1$ I$1$ (Q
Electric 1:1
Plumbing
Sprinklers
FI
Generator
1:1
Roof
=
Roof pitch
Total Sq. Ft of Construction: /
Cost of Construction: $ 3(000. 00
SFt. of First Floor: _
Utilities. Sewer Septic
Building Height:
OW NERAESSEE:
CONTRACTOR:
Name Miv
Name: 0
-W40, _
Address:ffl�,S DOCt(/c, y
Company: (
i
city -A6 State:
Zip Code: 3 �t 1 J ( Fax: u li4
Phone No. 1-12,- 2-52- q 5 255
-Humid npyr�
Address: tl0 A (LIMDI�tP_ YPI/� rCA'
City: (k Rif it - I - State: 'Fi.
Zip Code: 34g5�t`1 Fax:
Phone No '7a- `n0 (—� (
E -Mail: N I N
"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: W P 'WAk o CD rl
—DD�P
State or County License: k( 1$ I$1$ (Q
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: ,Not Applicable
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 thegermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anrt 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 1 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.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor' e�ner —
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF J11 l Q
STATE STATE OF FLORIDA c Liz; , -,
Li
COUNTY OF U . ;t Q�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this WoLdayof N=k .2019 by
this day of NaIZ6 20JI by
`Midnad f. %ig,
Michael f (3oyle,
Name of person aking statem nt
Personally Known VOR Produced Identification
Name of person aking st tement
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
(Produced
d�//�
(Signatur b tab�I��I�fF�iFtN�jlodCa
(Signature.*
- a o FI rida)
;• + ommission # GG 01 839
Commissi f •••' My Comm. Expires Aqg;Al 020
Commissi
.... CHRISTINE J. CON EL
.'"" `a �,, }�
o: Notar lic - State alml
A A
h National otary Aasn.
tla
Commission # GG 017839
_
%±.a �.?:• My Comm. Expires Aug 21. 2020 "
r
Notary
ssn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TU E
NGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17