HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Mol • 06 is
Building Permit Application
'Planning and Development Services
Building and Code Regulation. Division
12300 Virginia Avenue, Fort Pierce FL 34982
(Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR:
OE
Address: s5i 3 l m n_5 s Crr
Legal Description: -r� e g-do✓-r_ 66 nc]D" I ,n
PIroperty Tax ID-#: 3 V /0 r J-0 % Oct 00 O ` Lot No.
site Plan Name: Block No.
Project Name: CO-Jle o
Setbacks Front Back: _ Right Side: Left Side:
ditional work to be pertormed under tnis.permrt - cnecK all mai apply:
f
_Mechanical _ Gas Tank _ Gas Piping Shutters
_ Electric — Plumbing _ Sprinklers _ Generator
:al Sq. Ft of Construction: • Sq. Ft. of First Floor:
;t of Construction: $ LI sd Utilities: _ Sewer — Septic
Name (�� j"✓'�L1C J. C0,51C D
Address: 9 3L M
City: �a�J�flt' State:
Zip Code: e��-! `Z Fax:
Phone No. e;��62 ^
E-Mail: It'-IlA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Windows/Doors
RoofPitch
Building Height: ' -aJ ,
Name:
'Company: C-04d -/
Address: 2:
City: AV. A, e ✓C c `'' -��� State:
Zip Code: J�Zf V 4 Fax: 2i2� �,[�l
Phone No 77.2 ^V/_a%14
E-Mail %001, Si& i L to Vkkeo . rr'.vM
State or County License d'CGt3l/S%s08
I �
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: �l 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing w rk or recording r Notice of Commencement.
w
� r
�ignZatul-6'of Holder
Owner) essee/Contractor as Agent for Own r S gnature of Contractor/License
STATE OF FLORIDA, STATE OF FLORIDA l /
�v cfi. li c f
COUNTY OF -COUNTY OF v Z!
The forgoing instru,,Tent was acknowledged before me The forgoing instr}}17�ment was acknowledged before me
The
this day ofBwAriU , 20_.D by this day of i�$tl 202A by
?�vtisrts JrkuIs. IC 'T1A1Lk s Swett
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification _� Personally Known OR Produced Identification
Type of Identification Type of Iification
(ac�3t
Produced A0+ 4f* #14Vst. beso% Produced '1-t��+► I�IQ,I ,R.
�i aJt`1. o��aa
- to of Florida) (Signature of Notary P ic- Sta on
000`Fe ti6PSS�
Sign re o IVo(,ar,
NDovpZQofE onaa oQ
Luc,'
�1C1) D l blic State g41 Commission No.
Commission No. e ��ji n��ta9 2p22
`{e5Feb26. pszn•
ExP,onaksotar'
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REVIEWS
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FRONT
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'.SUPERVISOR
PLANS
VEGETATION
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MANGROVE
COUNTER
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
`
DATE
COMPLETED.
�ev.8/2/17