HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: , _ Permit Number: (��0� • OlQ�3l
-Building Permit Application
Planning and Development Services
Building and Code Regulation Division _
2300 Virginia Avenue, FortPierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 COt7 Mef Cial . Residential . __ _
PERMIT TYPE:
P:RO'POSED IMPROVEMENT LOCATION
:Address: cal r ZO
Property Tax.ID #: 3 u, _ 5'0 0O U 9 ..: Lot No.,
Site Plan Name: Block'No. '
Project Name: _
DETAILED, DESCRIPTION "OF WORK
-T(( `u V a 1�. 4� �W�.}�17 e jf evilf'..
CONSTRUCTION INFORMATION:
,Additional work to be performed under this permit - check all that apply: r
_ echanical _ Gas Tank _ Gas Piping _ Shutters _ _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:'$ `7 7'01' , d O Utilities: Sewer '—Septic "Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name au I P. G r b0ll i
Name: r/`i C L�Uv/'/tfu
Address: 7 �- 05.. /-f Zd
Company:.
City: Fc�.r+- : C'rc�; �.,n, State: rL
Address: 3"r6q..•."Fd�1 1 big
�.
Zip Code:.. �? Fax a;W ;,
City: �y (' :.. '�:ISce
,State:
Phone'No.
Zip Code:�i°� 7,- Fax:'..
•F:� �l �S- �f 90
E-Mail..
'on
Phone No l772 - L(, 100
Fill in fee simple Title Holdernext page (if different `
E-Mail VAYeA/'d+Z -±AC
Cdln
State or County License r L 13 U U S 17
from the Owner listed above),
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. -_ -
SUPPLEMENTAL CONSTRUCTION' LIEN. LAW INFORMATION:",,
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.
Inconsideration 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."�/v
. lz�
DESIGNER/ENGINEER: ``•
Name:
Address:
City:
Zip: Phone
Not Applicable
State:
MORTGAGE COMPANY:"
Name:
Not Applicable
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:
_Not:Applicable
Address:
City: "
-
Zip: Phone:
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA .. -
STATE .OF FLORIDA
COUNTY OF Swim- LU G{ ¢, CUu tl-III
COUNTY OF I—y
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of - .Ja1cx0Y , 20IQ_. -by, •� �:
this ZV_ day of 3G'l"�- 20 �.o by-
" j,cl-v U r,tiC�.�
Lc-l-o-rncaw
Name of person making statement.
Name of person making statement.
onall Know OR Produced Identification
OR Produced Identification "
Type of Identification''
Type of Identification - -
Produced -
Produced . -
-,1111
(Signature of N y - I a -
(Signature of No
4P40Y � Notary Public State of Florida
- Chris L Woolle
Commission No. '
+P�!►� � Notary Public State of Florida
Chris L Woolle�eal)
, mission�a456s5
Commission No.
ommission
Expired 02/26/2022
G 10 5 a/-
Expires 02/28/2022
REVIEWS -
FRONT
ZONING
SUPERVISOR`
� PLANS
VEGETATION -
-SEA-TURTLE.
MANGROVE
COUNTER
REVIEW
_REVIEW
.REVIEW
REVIEW ...
� REVIEW, -
: -.REVIEW .
DATE
RECEIVED
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DATE
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COMPLETED