HomeMy WebLinkAboutBuilding Permit Application NOV/07/2019/THU 03:33 PM ACCH INS AGENCY FAX No. 7724085501 P. 001/004
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ! d� Permit Number: I�L
a
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)4621578 Commercial Residential
PERMIT TYPE: ` L
'��� ,ti: s� �a. 2 �P' ',r r�� t ��''C��C�(!!�"CC`�y;��•�� ,� at�'pt��,y�.(,fyp.�'A+hi,r'-'.�. '� 'c}}y� :�;�;"'. ..F��'nti.�`t�Sd��•Syr'�a,.i, %k°m,�"*,'•�1.'�'-T`�f:'��w..V`. +`.c�,r
�..`.'���.0..••�� kY<�5f�}.r. ..�..'�%. _,.��'' '��k�'�F,'�' �Y �•:C.�.i w:'�'?l;r�t� °.Y4:�,:51. �n�.lpf�r, '�w�.:-;1�•:.igi}�{�4(1:_'F,+!<.tl�•t''t�Y�:°:n�:lE^S�yi..oG
Address: tt/� .!1 3
i
Property Tax ID#: J ` r- ( - nrr I✓ ~� Lot No.
Site Plan Name: /� m�A (Yl Block No.
Project Name• CUYI� I amF, co C
r i9. d, S:,l';YffiY et, '.i2'f;;: Yrci':;i.'•':' }'{rsti.9.-'..'•a'• �•',.�;;:,
.l p�'"�e �.1- ..yy:.��r.Ai� -�' '�i,.ya''+. �i e�f�j��''' 1'.�F^4.��-�d'i�` i'1���,� � t��•:1
•� ., ?',.�4'N I Y `.,��.
._ ..N" 5' .axJ,4:-.�a°F+s�i�itY.crwc°I.C�_,. t,.s:�•,��•..is;.�;c.�y....wt,tr,:t_,t�Fr."��3;r•.. rw,^,
\Ah
r )5 >1;',r ,- 1+ ^ v p r t, ', r CU � r�vr� Wt'�i r row ,
,�5�0 1,1 A l7 dn/, 1) A11Q by ��•
•S'� •py:
'e � •�, ,�y a :C. :�+ .V�. .ii t�." ...;v1:'i�� � .°�'•'fa�o� n t�°:, �y:,�,, t�!'•r'W.,__}}pp��S•"�.' ;4'�'tti,:.;ex,
,1 s, �y ii �„� `�i,. a .a w+Y,;l .t;'. J, i?�i °t. 's'-,�4• ;n,.•.a ��",�'.�
y S. 1. s ^"n'�q �• 'Y�:i��}v�' .f ,�� �r�q� .'�a]d e, 4y to y\.$J. � .Y':.,
77���s• .f�l1.� !b. ,�. .1'Fb�i..'�' �Ff ,l;aF`:v�.,•�i.:•,• � h v.N �',�.:� (1'�F'i,`.AJ �,'�d�:.�"'., 'l�i:'6 'a r a��`��,_iC�.:l.�;..a;
FO �.. ,' �iV ��• Fs' �i, k 11 , ''� �,CJ:�a"E`� TM'D��' �lt �:�e'�+, ',1--..a'., �F.) S4 l;�C:tx.•a•.� t..e:•., :,�1•n{,�
rr, re_,ry'+fs:”."��. -.�.:'c' .r •n:.r' Sw µ'ms'. .fi. ��.. 1�,. �'.�A �•P.c: .C= �: Ur L.'. v'.:�.N•)4,::'tt7 p 1t Y.:.:: iJ5
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank Gas Piping _ Shutters _Windows/Doors
\lam/Electric �Plumbing _Sprinklers T Generator �Roof Pitch
Total Sq. Ft of Construction: (� Sq. Ft.of First Floor:
Cost of Construction:$ r-9, /%�, CIO Utilities: T Sewer _Septic Building Height: _
•✓e, ;,r. .:.� »-..e' 7 'h .,V ^•e w s ,t 'r' r' er,:,c'-n 7r 'm:o•y T r 4s r ¢;k1+err; �'' a.
'�: c a1 w', i� � S s I r5%;;�.,..•:' f 3�vd'T.h't.,�.
�,.. va,1 , .+: .Jit 'l�+,T'";�l.r a:�j, i �L f*" f'.�, ;��•ti �'H' �r: :?,;;:.i�.N�,����!.;
i(r�]�/ �'�� $ �..5. 'i$F�F ,'��',�;', '4tCry"ter f,,';f4!k:giL'� ';�1. � � 't�ly''a i•,.�9. T? :c'^•ai;:� y';�)"5?vr2�:'�a',,•:�i%t: rSP>,-,f�':..j7
5.'!K•�r�Y.`._�i�`!" �� \"�V� y.,9.t,� :'a"�:.i5'it�i:F71.Yw:�ldi'u.k �ri:S4 •'.:�+i� 1� �����:�'�tr?>'+M K�Tpp�A:Y i t�'y..d,•:;..t! "; s.Y; ':rt
.r .a a,•.aa'.!'vi45.Y It ., Z. �✓:S. Arm-.. f R::n:S'::,if s �IKw., "f,S. �.c;:
Name iii et ,LP J"f Name: f'
Address: !i)0 e�I�C,f�L�/) DIL. Company:
City: —Stater Address: rL
Zip Code:�� Fax: City: )K State: 1'
,
Phone No. ftZ-,2.70 J f.qQC _ Zip Code: 3q� L1 Fax: 7%. - U- �5�1
E-Mail: Phone No-
Fill
o
Fill in fee simple Title Holder on next page(If different E-Mail �
from the owner listed above) State or County License E L 13 U 0 "7 3 O
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC Is$7,500 or more,a RECORDED Notice of Commencement is required.
NOV/07/2019/THU 03;33 PM ACCH INS AGENCY FAX No, 7724085501 P, 002/004
J.,. "r 1$' 3Pr.•.{�ty'75c;: -,GGa�1+ ;)„a,., .;q� .rz+�lil E�'{V.M,I•er�,yi+uz 'A3+c' ;,:yrl�F:r ..i'i'r1” ,@.<..• r".:�: •,�V�:r Gr'•�;,r,:w, '• r.•1
7 ` �, i .1{{� •(,i7, 1-� i 2,, ))3. t .,{ r •,?+••;+.,`•'l ,':"`�i'
•N x,..y 1 'J,• r�j71' :i' y J., � .'�` 1 N�' �.s..i h i,.a V4�i 4r i 'YEN`•�,Fi'z.P�'yf...'\" .(z;�::.; ..ai';,.
I% 13' ,a4 "�c.1•; asl$,...�z!t�?l,R .,rr .b, tvs� 1'.ur,11,%fSA,r..aai,:. e:,,.a;n•„',�:.r"e ..,:.5ry}:�v;•,;,r t;,
DESIGNER/IE:NGINEI=R: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address; Address:
City: State: City:------.---___-- _ .._ State:
Zip: Phone Zip: Phone:
FlEt 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.
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-resldential 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 iFINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.',
Signatt re'of Owner/,Lessee/contractor-as Agent for Owner of Contractor iE'ense Holder
STATE OF FLORIDA - I , STATE OF FLORID
COUNTY OF '; bicA. COUNTYOF ln)�,1 c
The forgoing lnstrutr�ent was�clmowledged,before The forgoing instrument was acknowledged before me
this `� day of �I�f;v'P,ti'n {+�P/i .2p U) by this day of 20 by
Name of person makin�statement. Name of person making state m'nt. •ho
"�t�N /2 $
Personally Known ice" OR Produced Identificat Personally Known �` OR Produced Identificati 7!
Type of Identification a Type of Identification ”'
a
Produced ° a Produced vKZ
p a> ti f3 25
o N
z� �" J I r` N d b
f r�
°•`% J�-� a'� . c'� L ¢gym
(Signa re of'Notary Public-State of Florida) , g ignatu a of Notary Public State of Florida)
°�•ri� ,.i i oaf
Commission No. tom(, 3c�p-r;(r,'S (Seal) Commission No_���. 3�. Q�7_ (Seal) g
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.