HomeMy WebLinkAboutBuilding Permit Applicaiton ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l ,, ,f,--( Jn
Date: — ^ — 1 <7 Permit Number: / O L
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Building Permit Application
Planning and Development Services 1
Building and Code Regulation Division
2300 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
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Address: (c 3q- Nle in6rl Cid, ►'rC.1-
Legal Description: Th' 'r\ Qc.we_ 2// ( LK. L LO I O
Property Tax ID#: 31-110- 3-(j31-1 1--000 CO Lot No. q
Site Plan Name: Block No. Iv
Project Name:
Setbacks Front Back: Right Side: Left Side: ,
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Additional work to be ertormed under this permit-check all at apply:
_HVAC II
Gas Tank Gas PipingShutters _Windows/Doors ,
Electric El Plumbing 0Sprinklers I I Generator ! I Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ \ d n
Utilities: Sewer I (Septic Building Height:
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Name '.. rics,n "e- exBUSS Name:03,x5E Pail, c -
Address: 6339- INlPcGn6ric . (Irde- Company: 140lT(,(1& F ' Ccd ( i
City: Fbr4- Pierce, State: FL Address: 1010 R\iV V.-LCIU1/4. x1 ?.,.[i .
., Zip Code: IL Fax: City: scl •Tieres)..> State:n .
Phone No. C11 0-5ao-- x1L 5 Zip Code: 31-19$a Fax:lia=4C.ot-46, 5
E-Mail: Phone No. ‘-"V- W-4(t1-53Dg
Fill in fee simple Title Holder on next page (if different E-Mail: 'cirr Sr _kida_C) GO`,Min
from the Owner listed above) State or County License:____EU.5001_ ____
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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OVONIATIVerfrWafralliiii
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DESIGNER/ENGINEER: I _ Not Applicable MORTGAGE COMPANY: _Not Applicable '
Name: Name:
Address: • Address:
City: State: City: State:
Zip: Phone I 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 bject structure
which is in contlict 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.
i
Sig to of Owner/Lessee/Contractor as Agent for Owner Sign.NeContractor/License Holder
_ STATE LORID9 \ STATE 0 FLORIDA
COUNTY OF (),LCUL__ COUNTY OF j4- 1_,.1 G-0
The fo going instrument was acknowledged before me The fo going instrume t was acknowledged before me
this day of , 29I1 by this ay of n , 20 / by
jcli-Nr\I-4 MO 1-we 0,_______-------- govy\04
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ,_--pL� Produced 97_ n(
K.,,,„,..
(Signature of Notary Public-State of Florida ) (Signature of otary P a '- _.:... -_ , ,
`- """'�, ELLEN VAUGHN
���"rr',, E VAUGHN °��s�;';State of(P9@q(>ja-Notary Public
Commission No. t� o.",� � Commission No. Y•
,,;�, '
r :_ ,., State of Florida-Notary Public *_ Commission#GG 270079
_* -"� *E Commission #GG 270079 rOrZ "�'i i io°' My Commission Expires
X941Ii,,,cv My Commission Expires 'int", October 22, 2022
',,„,,�” Outuber 22, 2022 4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17 .
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