HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -�-� Permit Number: 6$,d m
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Building Permit Application
Planning and Development Services ty, permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line (,a�
PR0 QSED IMPROpVEIVIENT LOCATION�n22�F;
Address:01
Legal Description:�X /C-f-s �.f G./� V d 1IVA�?- 914 6 6�- 9
Property Tax ID#:33 3 5-0 l -ON DOC) ,5- Lot No.�
Site Plan Name: ea,rj r'so gr-,s IJ 6_PVL,e- Block No.
Project Name: _ Pte(..JQ is,3 'e's Id ie,^-c-e-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION
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CONSTRUCTION LNFOR'IVIATION
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Additional work toe performed under tis permd-checka apply:
HVAC E]Gas Tank []Gas Piping _Shutters Windows/Doors
Electric El Plumbing �Sprinklers E Generator 11 Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Utilities. Sewer Septic Building Height:
QWNER/LESSEE a NTRACTOR:
Name (--. ' c d i 56 Name: J N-3 Sv v�
Address: 2- J� �+- C.ki( C ;✓ Company: c
City: Qac-4- l,g- State:_ ` Address:,-2 L3 / SC: '&?NkkP=c-c.% T-ur
Zip Code: '2>Lt`l $ Fax: City: :S4-,,.t'�— State.--R-
Phone
taterPhone No. y S��, ��R.� Zip Code: 3 `VT2 2 Fax:
E-Mail: Phone No. — Z SUS_
Fill in fee simple Title Holder on next page(if different E-Mail:-C-1)P 3JA ems-S . C-0/1'\
from the Owner listed above) State or County License:SLL L,33(_63
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _kNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ANot 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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR ff STATE OF FLORID
COUNTY OF R" Li�. COUNTY OF'
F
The forgoing instrument was acknowledged before me The for oing instrumen was acknowledged before me
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this ' day of JT ,20.E by this y day of '"J 20�Lr by
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Name of perso�king statement Name of person�ng statement
Personally Know Personally Known >�.:PR Produced Identification
Type of Identific i �o;;�,,, Jos�BADINI Type of ZNo
Produced . • GG274212 Produce "JOSEPHBMINI
DIRE 25,2022YGOMMISSIONIi(,'O27EXPIRES:Korernw25,
(Sign ture of Notary Public-State da) (Signat lic-State of Flo a) .
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17