HomeMy WebLinkAboutBuilding Permit Applicationr_
All APPLIIC��ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number: 3-Q)
Lon
:?020
• Building Permit ApplicatPlanning and Development Services ing
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: �3o�ar YcOo\ �A-P�A'o
PROPOSED IMPROVEMENT LOCATION:
Address:- ( ) on C . (� ei i ( 3L y
Property Tax ID #: L I Ll �o I )Oa03 o0 Q q / Lot No. 1/1
Site Plan Name: O a (71�-i (QF� 1 PJ`( Block No. (40
Project Name: 00 i ��� d' 11Ri 6. ` _CIF!a
I DETAILED DESCRIPTION OF WORK:
CONSTRUCTION, INFORMATION: .
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_Electric �(1Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
!-
bckyn!!11 I-RY4
Name:
t ZrA
Ro
Address: `a) C0k)c<-n Aor) 'LZT
Company:
Lv)ef
Cm
City: F� i kc,(Ge. State:EJ
Zip Code: yJli°I4) Fax:
Phone o. 5-i9 (off 9
ly(�
Address:
(o 5 ina 11W60
City:
Zip Code:
Phone No
Ple.f'Ce
L-i q P- Fa -
�x1:
'I-la(oL rf(pb�
State:
Lf(o O
q 7
�1 ]—�
E-Mail: C �q��erC�gd�.CAn�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail O q (CnCr � 0i tnG i C"o, M
State or County License
If value of construction Is $2500 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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owne ee/Contractor as Agent for Owner
Signature of Co tract! /License Holder
STATE OF
T Luel-
J I iLUCI�
COUNTYOFORIDA _3T
COUNTY OFORIDA(tr-
The for ping instryymm t was acknowledged before me
this�dayof hG 20.4Dby
The forgoing instr-urnent was acknowledged before me
this LAaday of Ckr 20aOby
beA Z.rg I kc k
�h ZraMOL
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 Identification
Produced
Produced
I Now Publk
State or FbriG Now .tl
(Signature of NotaryP blic State of Flori
B� My cWM1"
^� saw' Erol=12t2
of ota Public- St eo o6dVberly Large
n1Gf!'y&2e ry g `My Commisdon GG S4275
2027 Expires
[a l C
Commission No. L-1 a `J
'^^ Ile/ 1212&2023
A 14011
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19
61.0da.-1ay