HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q3�
Date:. 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) 462-1579 Commercial Residential ✓
PERMITTYPE: Re _r-oo F
R(7P<JSD IM1'RQUEMENTtOCATIONX4 r �'
Address: _3.5-f . J:hn_5�o_n `J -
Property Tax ID #: J? q0.3 O a C5 C5_3 - 0 UO - 4-1Lot No. 1 LI
J
Site Plan Name: Ohn'5'fion .61. Block No. L_
Project Name: JGh n 5 f o n
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Le:f Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: y�i Utilities: —Sewer —Septic Building Height:
Pitch
ft
-
Name .�tella n-fe r
Address: 351/ Johr-)S
Name: G I CI z� Inc
Company: DCejG1CF5S IR-&:s+oq ct7hG'7 Inc -
City: art Ai rc e State:EL
Zip Code. ,3 L/ a Fax:
Phone No.: -2 a - Z) l? 5/
E-M a il: J fe //0 ui-) e,Z_ 0 cjmai/ ccy,7
Address: 1- • I b rni cz rri i 1 ba i / *So
City: V?Q-f CFn r I c-k State: R
zip Code: % 5 Fax:
Phone No 9LiA-C���sr311�
E-Mail Dc� 1 LIS S f �S�G(�e f Gi'� qr�
Fill in fee simple`Title Holder on next page ( if different
from the Owner listed above)
State or County License C CC 13�SC DU 3
nr vajue or construction is :>2Suu 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.
.F,! 1 M`i :. uF ^�'- �+ •L ',-wG. T4 C .L...,,�' .4A `F }JYi'Y ik f 3- ,k,�iT� L d Y i'��ta?.� ?Sri}i t �`f� 1 `G' ! ( 3 � ....
SUPPLEMENrtAL�CONSTRU ION,LIEN IAWLINFQRMATlQI4'M
�i :5 ; a m e a
t:6,.a�-x. cf.e..,.+r, � n., h�'�,•L�2f.'.�ifi:?-.ram tr.'xFtwl. siG,,...,5-m.,. .f:A�U S.��Y.i ...;:i i. T� - n .�i i t4t3 vi� .. Li�i'..
s �.r -�S�} ♦�fsi.f.s �...�h. .. $I'v:M"' k:., :'*ye S, 4 .
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 -
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMFNCFMFNT_"
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF'FLORIDA
STATE OF FLORIDA
IDA
COUNTY OF (ri'so+q
..L
COUNTY OF G71-4So 1 G
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this H day of _�P brU_0 tG . 200 by
this Ai day off -brLt a rN 20do by
chc��l OU /0 Ss I J2 1
rr,7) c-ho& qlaSz rF v
Name of person making statem nt. ^ o L
Name of person making state ent.
Z;
Personally Known L� OR Produced Identi 04PM —'
Personally Knowny OR Produced Ident-
ibinN.
Type of Identification w o a
Type of Identification
o ;t
Produced g W-o
Produced
z� a z
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s�wo
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(Signs ure of Notary Public- State of Florida) ,m
(Signature of Notary Public- State of Florida)
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( ;�.y(��q7( '
Commission No. FFq ��U q Seal o
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Commission No. (Se
REVIEWS,
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 217119