HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / _
Date: co ' 7"' / Permit NumDResidentia lftL • ot) 7J
R RECEIVED
-- - Building Permit Appli
Planning and Development Services rtmentC
Building and Code Regulation Divisiony �2300 Virginia Avenue, Fort Pierce FL 34982 r FPhone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMITTYPE: � rQ-s,
P.ROPOSED-IMPROVEMENT LOCATION:,
Address: 3 :;(`tr2-
Property Tax ID O(5 24 "000_ Lot No. �l
Site Plan Name: // Block No. �-
Project Name: PqV SGL W1,01J0o LJ 1/VS7X4A_
DETAILED DESCRIPTION OF WORK:
D v6 o� C�6�� CJI�����✓f
54 Al'zVe GL S Od el-v5
CONSTRUCTION-INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: I e(if Lt Sq. Ft.of First Floor: [ Q 1(L(
Cost of Construction:$ Zi LO S7 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: ,_ „ C CTOR ,*rt �0 r:
ONTRA
Name C—LLI IXf d Name:
Addre : Company: •�- o.�rs; /Loi eF��J -Z�C
City: O GuGr G State: Et- Address:V 4?J-N6'- 4061WI G7
Zip Code: Fax: State:
Phone No. J-� /- 2,IS-- 9PIO Zip Code: 3 YrIJ Fax: 77 3 V-004?'
E-Mail: Phone No ,-,7-72,- Z(pG
Fill in fee simple Title Holder on next page(if different" E-Mail ��''� � �G<-[G�i• N�
from the Owner listed above) State or County License 6,17 C 19-2-010
3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
a 11
SUPPLEMENTAL CONSTR CTI® I!EIN LAW IINF®RMAI'I®N: MEN=
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 representation that is granting a permit will authorize thepermit 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN 5TTORNEY BEFORE RECORDING OUR NOTICE OF COMM EMENT."
Signat a of Ow /Lessee/ContrAfor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORI
COUNTY OF IT("�,c.A-1I) COUNTY OF Ia&�
The f r oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,5�M D 20� by this�day of J 20 _qby
Name of pers making statement. Name of person making statement.
Personally Known I,--' OR Produced Identification Personally Known t/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
•"'• MEMO MOT ERWA►Y EF=! `
(Signature of Notary Public-State o Fpr' MY C MISSION#t"PAITd of Notary Public-Sta gi is 'a '2
�Y COMMIS #FF +=
��95�75� �' • EXPIRES April 12;2020 =;i• EXPIRES April 12,,2
Commission No. Fm�WalloL a No.F •'' Sea Floddallou Servxe.
(407) (407)398-07
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19