HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t7�; I� Permit Number:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: 1
Address: _ 1 L4
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
GI(L �_tc UIJ-- ,UJ RtW RLU) 3 -bn 1� seer Aid,pQd(V 0 uni+ /U�h 10 Kul heat
Lot No.
Block No.
CONSTRUCTION INFORMATION:
dl a workto e e orme under this permit -check a apply: XHVAC Gas Tank []Gas Piping _ Shutters a Windows/Doors
Electric o Plumbing Sprinklers Generator o Roof
Total Sq. Ft of Construction: / , SgFt.. of First Floor:
Cost of Construction: $ .XPID.W Utilities: L _ISewer aseptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
4i
Address: 11450 OWL- C
LL '"
Company: �(p r fiV�ih1la HPlijbiG
IZl��UlrrX[
City: 1�(t 9('00- State:_
Zip Code: 3gI51 Fax:
Phone No.l{5O - 5SI - aD'I U
r1.
Address: 5106 A �iU,fY1�) U. �.P.�rp�{
City:State:_
Zip Code: .3 O 5 I Fax: 1 t{f�lP 373i
Phone No.-N t-NA-- 4Yp4-1-+1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E-Mail:r. r`
t
State or County Licen e: CAC, 1.91$13
It value of construction is 5Z50U or more, a RECORDED Notice of Commencement is required.
SUPPLEMEWAL CONSTRUCTION LIED LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Flame:
_
Name:
Address:
Address:
City: State: _
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER. � Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONMC170111 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.
Si 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 appimabte 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
j in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
i
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 tender or an attorney before
commencing workor recording our Notice of Commencement-
signature of Owner( Lessee/Contractor <s Agent for caner
Signature of Contractor -I icense Holder
STATE OF FLORIDA
COUNTYOF it. I 110'IP.
STATE OF FLORIDA
Cale
COLINTYOF
The forgoing instrument was acknowledged before me
loL
The forgoing instrument was acknowledged before me
this day of I�P.P,YYI�JP,� 20 19 by
this.ZM,L day of D9Pb 0&- 20_6_ by
Wchuet F &Ile,
I aCW F B le,
Name of person aking stitement
Name of persol aking stat ment
Personally Known OR Produced identification
Personally Known C.R Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Q�
(Signatureof •o l'It bhc--gyp" WELL
(Signature of - St at€Itlf19hpgEilB'ONWEJ
Notary Public - St QlfF,lorida
Comm Sion # �4fi7839
-r, �'_ Notary Public - State of F
Comrrti5sicxeN •_ Commission ;� Mill
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� F�os'Op My Comm. Expires Aug 21, 2020
Bonded
�« Fro;;.•'` y omm. Expires Aug 21,
Bontletl lhrough
through National Notary Assn.:
National Notar
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FRONT
ZONING
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
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DATE
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DATE
COMPLETED
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