HomeMy WebLinkAboutBuilding permit applicationq ALL APPLIC ,qLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: '� /`�► ���� Permit Number: did' 6�
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 I
-PRQPOSEI)IMPROVEMENT LOCATIO!N,,'
Address: —71 :a O"ii e Far+ pi 2 V-caQ � 1--L. 61
Legal Description: 6ar1c da (7At % - lUhr_JL- `I&-_y L.04-3 /n
Property Tax ID #: ha-34 -,56a - <5ou -ono- q Lot No. a 00
Site Plan Name: Block No.
Project Name: Tr-o 4 DQQe AQI&a_f '4)1�7114C4 e"I''r`��
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Setbacks Front Back: Right Side: Left Side:
❑ HVAC
❑ Electric
0 Plumbing
Sprinklers
LJ Shutters
11 Generator
Windows/Doors
Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �, C3�i��i Utilities:InSewer ❑Septic Building Height:
Roof pitch
OWNER/LESSEE �{ ..e
CONTRACTOR ,
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Name. 7- AJ i ih
Name: e a e'l
Company: Uf\Xr0 -�oW o ero G L.
Address: 6PA6
City: -Tafk PP -vc State: _r-L
Address:: 3 OS
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City: VCXQ each
State:R,
Zip Code: ;34Q5 1 Fax:
Phone No. S45 - 551 -gg40q
Zip Code: zo(
Phone NoC Z 2
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E-Mail: J
Fax:
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E-Mail: (2A n i rnm (f>45 0ctwrx.r! f . cay"
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: 6CC
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If value of construction is $25001or more, a RECORDED Notice of Commencement is required.
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SUfQ%PLEIVIENTALCO,NSTRUCTION
LIEN
LAV1/ :INFORMATION-",
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DESI(-3NER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name':
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 prohibitsuch
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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Signature Ow er/ Lessee/Contractor as Agent for Owner
Signat"2Confract License Holder
STATE OF FLORIDAI
'Z' ✓eY
STATE OF FLORIDA)]
COUNTY OFf0)
COUNTY OF 'y�cucan
The forgping instrumen waslacknowledged before me
The for,�Qing instrument was cknowledged before me
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this day of 1� 20 _L? by
this Zf day of 20 0� by
9doar % l I-ai n b
�05 , l� LaEad ,e
Name of person making statement
Name of peaking statement
rso
MOR
Personally Known OR Produced Identification V
Personally Known _ Produced Identification
Type of Identification FLML
Type of Identification
Produced
Produced
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(Signature of Notar ublic- �t,,te o FII 1
q6 4 C LEGGETT
Lav &1 0
(Signature of Notary ublic- State o lorida )
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Commission No. ��TO�`+� * Comr��l�r��#GG256926
"arr rOr DOROTHY C LEGGETT
Commission No. o� (/c C0mmis84G256926
2022
Expires Sept mbor Notary
nor «o Banded Thru Budget Notary Servkoa
oq• Expires September 19, 2022 1
Expires
r0l Bonded Pura Budget Notary Sorvicoo
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17