HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: –1 ~-313,-1, 1 • Permit Number: (-I ct-f-- No--
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Building Permit Application 4PR ® F�
Planning and Development Services ae,m/fr/n Zu49
Building and Code Regulation Division St L c9 pep
2300 Virginia Avenue,Fort Pierce FL 34982 e c nFy rt,„_
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _ Residential
PERMIT APPLICATION 'FOR:
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Address: i 59 Cth \u M 6 it OA.SAC
Description: StCJ��RI nl l( L CA 0 6 '.q f - '(j c i�K 1 0 L"�-
Property Tax ID#: cs9- .s 7O (poi Co non 4 Lot No. ZS
Site Plan Name: Block No. t 0
Project Name:
Setbacks Front I Back: Right Side: Left Side:
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(AILED DESCRIPTION@ «WORK° ° ; YaF
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CUNSTRUCTI® INFO( __ TIONP, ,_,, %.- , ' .. . ,
Additional work to •e performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Window /Doors
Electric _Plumbing _Sprinklers _Generator /p-Roof 3 )2– Pitch
Total Sq. Ft of Construction: /Vd0 _ Sq. Ft.of First Floor: /1 �0
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Cost of Construction:$ &DOD Utilities: _Sewer _Septic Building Height:
®WN�ERjLE�SEE° aen;a f. ONTRACT®R° .
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Name .�- (�- 02 Name: �c (1 P ca r a- (o
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Address • ` ' ,net• r ' o- t L Company: L) . ICS'U k
City: -{�� � �( State:• F( Address: 2.649 G . D Dt '- y 4•k -s
Zip Code: 34 5) Fax: kJ/a City: P�(a�f U C
SA– L .k State: `
Phone No. -ig' GO-9(7 Zip Code: 37 q5-e_ Fax: {J A
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E-Mail: Phone No l ?_ R"� 4 O
ll Fill in fee simple Title Holder on next page( if different E-Mail R1GVI%E U k-rF Ck`J L. G oi AMA l
from the Owner listed above) State or County License ra_J(, to-7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUUPPLEM EN ,�CSN-TRUCT®a l5 [N ®RMATIONo '-- ` '
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, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �J STATE OF FLORIDA r
COUNTY OF L . LULE-� COUNTY OF 4___
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The forgoing instrument was acknowledge efore me The forgoi g instru ent was acknowledged before me
this aoy ofA)}� ,20 y this Say . 1,, 20']j by
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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 Identificatio
Produced L_(j C, -- Produced \
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(Sig..,_,_. -.-U-,..1 (Signat --,• ► . .1 P .blic-State of Florida )
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REVIEWS FRONT Z� SUPERVISOR PLANS V G
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED -
lev. 8/2/17
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