HomeMy WebLinkAboutBuilding Permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 _x_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Des
P rope rty Tax I D #: IS01-(oIt) -t7CA4O -OGO - a Lot No. 1_7�
Site Plan Name: W � Il, III, iI04ylt T.G - ?-Cc-) �- Block No. 3
Project Name: W t \ \ \ GLfY1S "QL - egr_JF
Setbacks Front Back: Right Side: Left Side:
vas"rFcAAt Ntw SV c(in,y M&4-0-� CaOC,
nn 5u IIICU unuci 1.1114yci Rus -UICLrc an apply:
OHVAC Gas Tank ❑Gas Piping _Shutters Windows)/DD�oo�rs�
11Electric Plumbing Sprinklers Generator F,,A I �f/1�1 Roof pitch
Total Sq. Ft of Construction: O(, 0 3 S Ft, of First Floor: ` 0
Cost of Construction: $ St �(� a Utilities:�Sewer E Septic Building Height: 1 51'ix
0 W N E RAESSE E:
CONTRACTOR:
NamemeMin A ,MOL 2S
Name: Q uIs
Address: U46S D)(X
Company: Cl
City: ?iur-e- State:
Zip Code:_ Fax:
Phone No. --7 7� - q gi377
Address: e?3(D—I 14M vY-
City: AYi LIAA f A L State: FL
Zip Code: 3L65 � Fax:
No. 1
E -Mail: n IPhone
Fill in fee simple Title Holder on next page ( ii different
from the Owner listed above)
E -Mail: iyt
State or County License: — 1
-•-� �• •co••s•N...•,•.,I ,s 4—w w, n,u,e, a RECORDED Notice or Lommencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
of Applicable
MORTGAGE COMPANY: of Applicable
Name:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: ',nNot Applicable
Name:
Address:
Ohn Il&) SSS
Address:
City:
City:
Zip: Phone:
Personally Known OR Produced Identification
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 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
rnmmanrina wr&L- nr rprnrdina vnur Notice of Commencement.
Rev. 8/2/17
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Signature of Cor actor/License Holder
Signature dt Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
1�
OF 5t
COUNTY
COUNTY OF ,�,_ f
OFORTATE
I Lar I G
The orgoing instrume t� was acknowledged before me
The forgoing instrument was acknowledged before me
this day of ar\e 202!:� by
this da of 2 b
LYS
�5I_
Ohn Il&) SSS
Name of person Ing statement
/OR
Name of per n making statement
Personally Known Xo Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
� n
�/�.0 ' n 5 tl V V�
Produced
�LOQJV19 11, &J0004
(Signature of NotaryPub lc- ate of Florida)
(Signature of Notary Public- State of Florida)
Commission No. (SaaBy PUbk State of Fimi
C mission No. 81ar6orFlorida
KeMi Mosa
W=Wyapublm
JDeenM SabellaAMy
Cammo GG 308996
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My Commission GG 22910D
EMµrea 0 310 7120 2 3
Expires 09!1412022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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