HomeMy WebLinkAboutBuilding Permit Application` ALL -APPLICABLE INFO MUST fic COMPLETED FOR APPLICATION TO BE AC rri ED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 g /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
I PROPOSED IMPROVEMENT LOCATION: , III
Address: 5722 -leY2ee- Lake 0z rT Piciere— Fl 35119/
Legal Description: �N1270 i~ Sgel) r., PAO5e 3 ZQ_f15 7
Property Tax ID #: / V *1 ^ S n; - (5o / 3 Coo - y Lot No. .5 7
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
0 RLe,,AA-&VQ- A W i mot,
CONSTRUCTION INFORMATION:
Gas Tank
GLvAcrt C'f*11J I l'l a S/Vc
Piping
1-1 Electric 0 Plumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Block No.
oe •%/usr_
Shutters Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor: _
Utilities:ll Sewer ElSeptic
Building Height:
OWNER/LESSEE: _
CONTRACTOR:
Name 48URIeye- l-lodlela
Name: ../_z-19VD
Gee �7
Address: -S7 2 2 10J
Compay: OP -
City: State:_
Zip Code: 311951 Fax:
Phone No. 7 -1 Z. - , 5'C7 / - 1/ O "4 5<'
Addreesss`:Z.D TG
City:/! IPl2cE
Zip Code: �L( % q Fax:
Phone No. %L ' 7 /'�
State:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: tC�2 L:L� Flu
//yy,
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State or County License:CG'C /_66199s-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address: 0
City: as State,
Zip:. �2 Phone e
FEE SIMPLE TITLE HOLDER: _ Not
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Address:
X9
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 1 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
rnmmanrino wnrle nr rPrnrdinP vnur Notice of Commencement. /?
I
IF
Signatur o Own Lessee/Contra or as Agent for Owner
ntractor/Li ns r
Signa ur7FFIL'ORIDA
STAT OF FLORIDA s
STATECOUNTYOF�COUNTYOF Ve � (%er�
The forgoing instru ent was acknowledged before me
thisL day of - 20" by
The forgoing instrupent was acknowledged before me
this /d day of / E � 20M by
Narob of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
+✓� Notary PuwbaSlataol Fbrida
t 'IEfI
.✓ Notary Public State of Florida
'/,(�� Shitley Clark
(Signature o Notary Pu i ofl6fYt}alakn aG iz7eDt
on a27551
(Signature of otary Pu i' o df?d;ri�e'Tonoz3
a nwaowaewa t.�I1n07J
- -
Commission No.(Sea
Commission No.(;o I ��
I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
1
COMPLETED
Rev.8/2/17