HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIC B.L,E IIN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: :3 Permit Number
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Building Permit App
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
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JUN 0 2 2020
Permitting Qep-rtment
St. Lucie r�tyr FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address: .W 11(ERWW11,9C`y/Jve
�Ocs' -l-h P(I A-3 teW V-# s ,. Ors,' 110.E zR (1 701 '>vv,5 /.,C SL.
Property Tax ID #: 13— Lot No.
Site Plan Name: A et /al�M Jrroo %�v.'7` �2` Block No.
Project Name: z0 --4 r cL�PJ�rJPi✓�P
Setbacks Front ZS. !0 Back: Right Side: 8 Left Side: 3
DETAILED DESCRIPTION OF WORK:
S;ice �� Pn,Jt7 a G�u�ir, are
�3Ve"
CONSTRUCTION INFORMATION: �. n
Additional work to b
M ormecl under tis permit- checK all apply.
I&HVAC
Gas Tank
L_JGasP.,
_Shutters
W
Windows/Doors
FFrq
Electric IS Plumbing
Sprinklers
Generator
5_1Roof
EZ Roof pitch
Total Sq. Ft of Construction: Z
%� y Sq.
Ft. of First Floor:
Cost of Construction: $ 2/t ay` o, ft Utilities:
Jnlsewer
E Septic
Building Height:
OWNER/LESSEE:
C,ONTRACTOR':., , e. m
Name ,4v ;e ✓ i
Name:
Address: q>-/� S��' CA✓ iu%
Company: vC.4S
-
City: e ' �a�G State:
Zip Code -am Z rFaax:
Phone No. 77Z ` 5- 7-06zr
Address:
City: A.Z QR
Zip Code: J Z
Phone No. 1'79 -X-6 7-
State: ?rC
Fax:
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E-Mail: P1cia4.1 ('I 7y(-) 46/. CIM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: A Ige-4-,! yyO�
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State or County License: CXf
.. 6 '74
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAI�C(jNSTRUCTION'LfEN tAW INF,ORNIATION
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y
DESIGNEWENGINEER: Not Applicable
Name: leew.✓ce S'o!j%/
MORTGA CO PANY:YfnnJ
Name: filffn1 nvr/u..e._o_
Not Applicable
Addres : /� 7S -'TQ RIC1
City: W40 13 w State: )=c-
Zip: .Uf6 o Phone 3 o-'/!f9Z
Address:
City:
Zip: Phone: X`O/
State:
Zs/7
FEE SIMPLE TITLEHOLDER: X Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
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 ying twice for
improvements to your property. A Notice of Commencement must be recorded and p:;) ecj on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an Otto �ney before
comn)4'n)-ing work opfecordtig your Notice of Commencement. If
C
SigAturedofer essee/Contractor as Agent for Owner
Signature of Contractor/License! Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF 121D1;
COUNTYOF��ne(za
The for oing instrument was acknowledged before me
ng instrument was acknowledged before me
TheEze,),f-
this day of 20Z by
this of 20Zp by
n cay ( (u r�-
L o raD
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification 11-1/1
Personally Known OR Produced Identification L/
Type of Identification
Type of Identifica��fl1on
�.
Produced -� 0 / _
Produced -F-L
(Signature of Notary Public- State of F KULBIR K. BANS
IL (Signature of Notary Public- State of Flori KULBIR K. BAI
e NOTARY PUBLI
Commission No. o 1 STATE OF FLOR
a o NOTARY PUB
Mmmission No. 7/ t7i� g I) o STATE OF FL
o
• =Comm# GG0712
a ComrNl GG071
ONCE 19�" Expires 218120
1 cE to a Expires 2/8/2
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17