HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2- �� ZC� 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
Address: Q,_3CA f�_ C 11'(�11Q(e d')Cf I,tUL t L 3G(c
Legal Description: Bi t Qi�_C~, i �e of PCA V i11C(QC Ut a-)
f CAP- -3q ca - 2n GS)
Property Tax ID#: , j,3'Z2-- `3 0 I CXD:�;5— 000 1 Lot No. -30
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
.i-�ii;Mp
Block No.
CONSTRUCTION INFORMATION:
Additional work to be
ve orme under this permit -check a apply:
EIHVAC (—! Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
11 Electric Plumbing IJ Sprinklers FIGenerator n Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
2 200
SQ.
of First Floor: _
Utilities: L_I Sewer a Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name &-8tA
Name:
Address:
YiCip2 r T-Cice
Company:
06>1 M� pbb(
i\J[C.e-
City: Fd( .-
Zip Code: 3gcfy b
Phone No. 5�1115' 73q
l�JC-i`- State:i=L
Fax: e-)
- (277 CC
Address:
c bat 1
9U'e
City: P)LF
Zip Code:
Phone No.
34 O vl Fax: -n?,-a)kScg2z
-772-" 3 .._ `_SCc(D_?
State: L
E-Mail: n I Ck-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: IT l DIE V2 (D L Lk -%-3 P '` &VTX) ('"
State or County License: C_PG 1 qr-) 9L'-7-g
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
— pp
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY; Not Applicable
Name: Name:
Address: Add Tess:
City: State: City: State:
Zip: Phone Zip: Phone:
,FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name:
Addre!
City:_
Zip: _
Phone:
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTORAFFIDVIT: 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 your Notice of Commencement.
nX
i natur of Owner/ Lessee/Contractor as Agent for Owner
S:_ _
igna rev Contractor/License Holder
STAT FLIDA
STATE O ORIQA
COUNTY OF
�:, ��
COUNTY OF
The forgoing instrume,61 was acknowledged before me
The f rIging instru t was acknowledged before me
this _U _1 d-ay of
� by
this )'day of �; : ? Li 20JJ by
_
Name of person making statement Ll�'
Name of person making statement
Personally Known
OR Produced Identification
Personally Known OR Produced Identification
Type of IdeaM
Type of 1de tifi ti .
t_ , " 1
Produced
� \
Produced
(Sign atgreflfTVot Publi
- orida
(Si nature of No u ' , to Asa
Commission No,
al,`�
' ' ^ ��'4 ,
' fission No. ��"� ea
`� 'i'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Building & Code Compli��ace ivisiOB
_ BUILDINGtstaR:+ 11'
SUB-CQWRACTGR fiGRI E YE N
El
tv cA I1ave agreed to be
(Company Natneltndividtia3 Name)
,- `t rrc >✓ .__ Sub -contractor -for _ _aI � __ ___-'_
i`f apea '"('rade) (Primary Contractor) J�
For the project located at ---�- 30 a kedu)00d-- U lv e, TQ0- _Pi f-c-e
(Project Street Address or Property Tax III ;1)
It is tinderstood that, if ttlere is any change of status regarding our participation with the above Mentioned
project, the Building and Code Regulation Division of St. Lucie County wilt be advised pursuant to the
filing of a Change of Slab -contractor notice.
aC
SUB- ON ACTO#2 SIGNivriiR[: (Qtiiitiiier)�
( ou,,i I 1 CERTIFICATION NUMB, t COt7tw F�' Cis Rt IP%IC;1'r10N iVI3t4iB`f?I�, ,
S -ite of Florida, County of'4 - � L�
Theforegoing inst€ unteut was signed he{fnre ntc tills
•� -_ day of The Foregoing instrument was signed
hefo€ a ttace #t�:is ice? t[a}�°Qni'
t i ss 3r Zo rat- t, jlY__ - _� - ..1—LL ..
,_ ff_- _ I
who is personally known g^or has produced aY ✓ _ f e.r iviao is L
or has prod ccd aas identificatio€€.ns itiert#ir€cati n
�j
�j r1i!'II'
Signature nt ,'€€ ary P€€ ie Signature F Not. � I ubiic
tot
--� — — Print Nine of Notary Public
Print Name of Notary Public
YP N�NENriRt{ � $G r�aiZ#NETifE)PAPStN
a°„ + t�SY GOMN1S3t4P! GG 041A42
Notary Public, State of Florida
EVIRM. Juno 13, 2020 Commissit}n# GG 9$4212
Revi;edIM612UtC, BondedThwNotary:'ubiicUttdetitite
;r��, MY comm. expires Nov. 7, 2023