HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FC R APPLICATION TO BE ACCEPTED
Date: Permit Number:
! i
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Fierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: Q�
PROPOSED IMPROVEMENT LOCATION
Address:
Property Tax ID #: `(b``� - i - 0 I b0 I Lot No.
Site Plan Name:. Y t"-� Lot *�— Block No.
Project Name; "� floc �-A coo r4✓
DETAILED DESCRIPTION OF WORK:
Q._ C4-,.: A,,_ .--� Cid
CONSTRUCTION INFORMATION:
Additional work to be performed under this
_Mechanical _ Gas Tank
_ Electric , Plumbing
Total Sq. Ft of Construction: \9�
Cost of Construction:
mit - check all that apply:
Gas Piping _ Shutters
Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
cc:
_ Windows/Doors
J Roof I� -%1 Pitch
Building Height: J.(3 L
OWNER/LESSEE
CONTRACTOR:
Name M6L� >J cIda,
Name: d ra
Address:
City: �02:v l�Qr�-�
Company:
State.Address:
ii`\j S . �o�i Sr Uacs .sQ 3
Zip Code: ^�`�°� Fax:
Phone No. - "y '� �
E -Mail:
City:9d'--C L > ��� State:LL
Zip Code: 3'{ -% S Z Fax:
Phone No 117-- bZro _ s7-5 O _
Fill in fee simple Title Holder on next page
from the Owner listed above)
if different
E -Mail 41.4 S ( , "�� e "��'��_(,&,A °L--
State or County License CC(- " t%3 l V3 R
if value of construction is $2500 or more, a RECOIDED Notice of commencement is requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNERJENGINEFR: Not
Name: �^
Address:
City: `
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Aor
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFiDVIT: Applicata'
I certify that no work or installation has commenc c
St. Lucie Countymakes no representation that is gr`
which is in conflict with any applicable Nome Own$r
structure. Please consult with your Nome pruners
In consideration of the granting of this requested p
in accordance with the approved plans, the Florida JE
i
The folloA6ng building permit applications are exerol
accessory structures, swimming pools, fences, wails,
"WARN NG TO OWNER: YOUR FAILURE TO
TWICE FOR IMS" ROY•EMENTS TO YOUR
POSTED ON THE JOB SITE BEFORE THE,
WITH YOUR LEIMER OR AN ATTORNEY aO
s0at-ure of owner/ Lessee/Contractor as Agent
STATE OF FLORIDA
COUNTY OF 5t Lucie
The forgoing instrument was acknowledged befc
this 29th day of April 2020 by
Namw of person making statement.
Personally Known ✓ OR Produced I
Type of identification
Produced ---
(Signature of Notary Public- State of Florida)
Commission No. •.��a_aaz3si (Sear
°ro,ac r ct+oai"A409M,2022
REVIEWS FRONT ZONING
NING
COUNTER REVIEW
DATE
COMPLETED
rvE: s: sutvi
MORTGAGE COMPANY:
Name:
Address: —
City:
? Zip.. — Phone:-
V Not Applicable Y
State: '
icable BONDING COMPANY, Not Applicable
t Dame:
_ Address
city,
Zip: Phone: i
is hereby made to obtain a permit to do the work and installation as indicated.
prior to the issuance of a permit.
ting a hermit will authorize the permit holder to build the subject structure
Association rules, bylaws or and covenants that may restrict or {prohibit such
,ociation and review your deed for any restrictions which may apply.
mit, I do hereby agree that I will, in all respects, perform the work
Ading Codes and St_ Lucie County Amendments.
t from undergoing 8 full concurrency review: room additions,
Signs, screen rooms and accessory uses to another non-residential use
CORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
10PERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
'IRST INSpECTIORL iF YOU INTEND To OBTAIN FINANCING, CONSULT
FORE RECORDING YOUR NOTICE OF COMMENCEMENT_"
T Owner Signatu�nf ontractorJticense lc#er
STATE OF FLORIDA
COUNTY OF
me The forgoing instrument was acknowledged before me
this _ day of ---- 20 by
t
Nome of person making statement.
ion Personally Known —OR Produced Identification
"type of identification
Produced ----
1
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
P£RVISOR t PLANS } VEGETATION -% SEA TURTLE
EVIEW REVIEW REVIEW REVIEW
MANGROVE
REVIEW
FLORIDA INDIVIDUAL ACKN
F.S. 117.05(13) — Effective January 1,
State of Florida {
County of :+
.+M? REBECCA MORRIS
W COMMISSION # GG 0$0347
EXPIRES: May 7, 2021
Bonded Thsu Rob" PubtlG 4)nderxtlters
(Place Notary Seal Stamp Above)
Attached
Complete this section to deter alteration of
Title or Type of Document:
Document Date:
MENT
The foregoing instrument was acknowledged before
me by means of
khysical Presence
r: Online Notarizat' n
this Q*day of 1 1 20_X, by
Person ,(j(eknow ledging)
Signature of Notary P i State of Florida)
(Printed Name of Notary Public)
Personally Known
LI
Produced Identification
Type of-Idesitification Pro used:
ulyuLs 15c,
nt
document or fraAulent reattachment of this form tp an unintended document.
Number of Pages of Original Document:
Signer(s) Other Than Named Above (i.e. +itnesses, minors, etc.):