HomeMy WebLinkAboutpermit app TorellALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `7 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:.
Address: ' 60 ij 4,-/C (_t -
Legal Description:Z-D t32-5 31k— 7 L�� 6
Property Tax ID #: 3 zJ'5_
Site Plan Name:
Project Name: TO t'e— t
Setbacks Front
t10 1 D03 S1_ 000 2 -
S �',t e_, -Lc e
Back: Right Side: left Side:
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Company:
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Address:3-71 Si r ''���� -�—�s^
City: SGd 1' State:E6_
Zip Code:3 til 1 Fax:
Phone No. 7'L- e - 2-5-0 s
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: Lb f� 901 5 Lr� ntit
_
State or County License: 6 L 1-32r63
Lot No
Block No.
2g
I
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit —check all that appy:
HVAC Gas Tank FIGas Piping _ Shutters Windows/Doors
Electric ElPlumbing Sprinklers Q Generator F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:Cn Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �. tl 1 s -1
Name: Lolh''5 "'x(4,6
,`
Address: 141-04 I,'4 -,y f7,
Company:
City: °FTP LJ�E� State: TL
Zip Code3 1'? Fax: ,r•
Phone No,r L 9!7/ / f] l� ' /
Address:3-71 Si r ''���� -�—�s^
City: SGd 1' State:E6_
Zip Code:3 til 1 Fax:
Phone No. 7'L- e - 2-5-0 s
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: Lb f� 901 5 Lr� ntit
_
State or County License: 6 L 1-32r63
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: of Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ t Applicable
Name:
BONDING COMPANY: Not Applicable
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
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Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIp►
STATE OF FLORI
OF
COUNTY OF I
COUNTY
ent]mas acknowledged before me
The forgoing instru /
this day of 20 1,0by
The for oing instrument yeas acknowledged before me
this day of &2 I . 7-0 W by
Name of perso along statement
Name of perso aking statement
Personally Known VOR Produced Identification
Personally Known OR Produced Identification
Type of Ide ifiratinn
Type of identification
Produced "; ` . 05ERNI AD NI
Produc
OSEPH �D1Nt
'
MY GiIMMISSION # 92
' ABY'COMMI N 274212
�•
°F' T}i1El�IUFdIj�
(Signature o Notary Pu ic- tate o onilI a
(Si a
Commission No. (Seal)
Commission No_ (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17