HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ol A 19 Permit Number: flip , o I I(0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
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:IMPRROVEMENT LOCATION::
Address: Q_L I S MS I-�iC1L.CJG\I
Legal Description:Si Lu Cl -ec C GrAQl-,S to L4 0 B L.IL Z IeOr OII
��4J W US 1 L �! qLI DF �SeC (Lur( S ELI A 1_6 SD
Property Tax I D#: 3L+( f� 50 1 1809 3"1 G-I Lot No.
Site Plan Name: Block No. 7—
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�pIGCe ' 3 40^ PGC,K-G tM��- on rooF w;i-L, 5 Kw I�e(nker J
CNSTRUCTIOWINFORMATION.,
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Ad ditional work to be erformed unifer this permit-check all apply:
IHVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers E]Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ LO(95.00 Utilities:OSewer I leptic Building Height:
OWNER/LESSEE:, CONTRACTOR
Namel7-
&O01i. -^Z) fID�,p(& '663� (06-h P4(:hl Name: Z
Address: Company: 0I&rC&C1WLz 191ir O - el
City: State: Address: `i�
Zip Code: 1123 Fax: City: i6 t_ State TL.
Phone No. 12)`�`"(y^SO—I (p Zip Code: 3 6 R`'f Fax.
E-Mail: Phone No. (-1-12,� 11 I lnLtl
Fill in fee simple Title Holder on next page(if different E-Mail:4F Ch lb GC? laKf/'S CZ &01. Con-
from the Owner listed above) State or County License: Cat'( �In i1 01 to
i 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: 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 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.
Iri 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature caner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
1 STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF UC L COUNTY OF ( t
The for ing instrum��(( s acknowledg d efore me The f49{,r��oing instrume t s acknowledg be me
this day of U�L 2Dby this `lam day of 20by
Name of person making statement. Name of person making statement.
Personally Known V u d e ti i a o ersonally Known `�
Notary Public State of Floritli
Type.of Identificat' ,p fro
pe o dentific n #0 Notary Public State of Florida
Lauren Brusati ,Produced Wy Ctxntrnssion GG 166770 du ed Lauren Brusati
ey texpIros.12/1012021 issan GG 166770
e, Expues 1211012021
(Signature f No ry ic-State of Florida) ( ature o c-State of Florida)
Commission No. (Seal) Com issio 0. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE _
RECEIVED
j DATE
i COMPLETED