HomeMy WebLinkAboutBuilding Permit Application 'I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 51A/9 � Permit Number:
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Building Permit Application AfAY2 4 2v19
Planning and Development Services Perrnittin
Building and Code Regulation Division St.Lu 9 departure
2300 Virginia Avenue, Fort Pierce FL 34982 Countynt
, Phone: (772)462-1553 Fax: (772)462-1578 Commercial _ Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED`IMPROVEMENT¢LOCATION:
Address: i b lb ` \, M I ru0Ry g- <,
Legal Description: p *e_ 0.:14'i 5li( i Lj s 15 -1-c) ,;(3 INC PSD S IO4 Vac Alley
p 5 ()NI is-LESS 1\1 - )5 F-t OF W 51=7 OF 1_01 Da (0,51A,C) bfL 1588 a 1
Property Tax ID#: 31-10-4--5O1-C-N-COO-(Ti Lot No. I S
Site Plan Name: Block No. 91
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: `° t
:_r_nsw1 eY -c buildir- 51 n and Iano5C[zpQ, II h . '
CONSTRUCTIONINFORMATION:
Additional work to be erformed under this permit-check all apply:
ElHVAC Gas Tank fGas Piping _Shutters ❑Windows/Doors
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YElectric El Plumbing (Sprinklers LI Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ c9)kic .00 Utilities:11Sewer ElSeptic Building Height:.
'k OWNER/LESSEE ` ' CONTRACTOR:
Name VoAph haml'id 1�'‘c�caaNz Name: ,Ai,mP_s C L . M())*D3O
Address: 1?, `IO - \' \--- tUA1'?,k` Company:H(u IR` E kr:y.1(A1 O�aC S, ,
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City: c\ (R�eCCQ_ 1 State: V` W Address: 1(O1O �ICItA EU i
Zip Code:
City: Fl. PI eIrce) State:
��lQ,'� Fax: ,
Phone No. 1%3- I-165-L11)9 Zip Code: -31--vm. Fax:
E-Mail: Phone No. 19 a- AICD 1- .83 2
Fill in fee simple Title Holder on next page(if different E-Mail: ,ionvS(Y )-t0(7�0 OO . QCrn
from the Owner listed above) State or County License: 'oC.: y 3� I icII
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -
DESIGNER/ENGINEER: i _Not Applicable MORTGAGE COMPANY: _Not Applicable 1
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.
Sign t� uute�of Owner/Lessee ontractor as Agent for Owner Signature�f Contractor/License oltbr
STATF
OFLORIDASTATEOFLORIDA
COUNTY OF Z k U - COUNTY OF A
The for oing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this '� day of (/ / ,20 by this 24 �� ,20 lc byday of �
3C, t\f\CC\lik,_ aG min GR akula,
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 r-lc i)L Produced bL1
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(Signature f Notar Public-State of FI da) (Signature of Notary Public-State Florida)
d�w'r''4 ELLEN VA J
Commissio V�b`p yah(=,State of Florida-No ary..PPublic Commission No. - Saal
."–''� *= Commission # GG 270079 ""' . ELLEN VAUGHN
tpPY PV i
-;,1, 11:,A• My Commission Expires i° r,State of Florida-Notary Public
SIL+" O"�tober 22, ' 2 — r^^^°n^°^^ #^G 270070 -
%+,.° oe� My Commission Expires
REVIEWS FRONT ; ZONING SUPERVISOR PLANS VEG =A�'Ib ' S_E7Ttfg?t NIANGR-DVE
COUNTER REVIEW REVIEW REVIEW REQ
DATE
RECEIVED ,
DATE
COMPLETED
Rev.8/2/17
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