HomeMy WebLinkAboutpermit app-ApthekerALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
CWPM
C)ru iV T Y
F L O R 1 p py
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: D C--,--,,.1
Legal Description: ezyc_ -,-\ "c- t A
Property Tax ID #: 17A ( !S C) b®
Site Plan Name: 4n,Lke-ke- e9
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
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000 L
Right Side: Left Side:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work toe e Orme un ert ispermit-c ec a appy:
HVAC 11 Gas Tank 0Gas Piping In Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers 01 Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _56 1�7 1 e J
SFt. of First Floor: _
Utilities:n Sewer O Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namz_l c- V
Name: Cit' ✓� f,
Address: -/071)1 Cao' e_10P1 C__
Company:
City: ors f Li r ` State: +%
Address EbprYV n,�e,1T_e_
Zip Code: 3 V I Fax:
City: 's4yar State:B�_
Phone No. 6,31- 705-- 61 �1 2!
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Zip Code:1� 5 �, / Fax:
Phone No. 7? Z
E -Mail:
Fill in fee simple Title Holder on next page ( if different
E -Mail: LAsr'o j ,
State or County License: -)Lc= �'�j `�6 7>
from the Owner listed above)
�� .0 Uc u {WllaAl N4%.lull 13 ?Iuuu ul MUM, d KELUKUtU immice OT LOMMencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:Not Applicable
Name: J(
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
At
BONDING COMPANY: _/NQ., 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 stnktures, 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 work or recordine your Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for owner
Signature of Contractor/License Holder
STATE OF FLORID
COUNTY OF
STATE OF FLORI
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this2a day of 20 LO by
this 2- day of 20 Z-6 by
Name of person aking statement
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Name of person aking statement
MOR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Id
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Type of identification
Produced
Prod �-
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(S nature of Notary . - State of F on a
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Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTf<E
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
CO M P LETEQ
Rev. 8/2/17