HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date:... .. 3 Permit Number;
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RECEI`.' D FSB 13 2017
Building Permit Application
Planning and Development Services
Building and Cade Regulation DlVlslon
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
PRO POSE D'1MPROVEMENT LOCATION
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Address:
Legal Description:
r-A.J#L �' t0t JbLY. (5 rt u-�V M e� Dl�(r 1'b Y��IU 10 We- tj Zr1.01 1'•1 00.) i°r► p��
Property Tax ID#: Gl S•(� ' « 'GG LIL ' 2 I O • ,b Lot No.
Site Plan Name: f��� Block No.
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Project Name: t L,%� MVV I
Setbacks F BacR: ig �(•//�
DETAILED gS�RIF�IQN'QF VVQRK J
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CONSTRUCTION tNFORNIATIQN
Additional worK toorme under t is ermi —c ec a appy:
HVAC UGasTank Gas Piping _ShuttersWindows/Doors
[]Electric 0 Plumbing Sprinklers 0 Generator Roof WR Roof pitch
Total Sq:Ft of Construction: 23dy. S .Ft:of First Floor:
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Cost of Construction:$ �y,9G(y• `�'� Utilities: Sewer11Septic Building Height:_
WNER/LESSEE CONTRACTOR
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Nari�e t,J yl.I.jtMY►ti fb1/1-.Ou�N Name:. 'cS64tJ 'S .1 ISO
Address; L11 AO-'4-N ZWtWV % Company:oJe?L -Ilk/Tor'2oor. iLv#PkK
City: ZLpNSL'N j,3L'/�rC.I.F State: Address: 5"�1 SU" k/Ic ik�l'K-y,uC� �:�•
Zip Code:01 SPS Fax: N�� City: 6:00A-A V-t-IT State:' ' L
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Phone No. 07?0 7 Zip Code: 3(1oYq 2 Fax:
E-Nleit N�/� PNahe'Na: > 4dif
Fill in fee simple Title Holder on next page(if different EmMail:00tey -^0A <dP RUt Crl�°�rd L•C
from the Owner listed above) State or County License:CGG 133 q Z
If value of constrUctiori is$2500 or more,5 RECORDED Notice of Commencement 19 required.
SUPPL MENTAL CONSYRUCTI N LIEN"LAW INFORMATION
:. .,: ,.. oe-
DESIGNER/ENGINEER: Nool Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
Ole
FEE SIMPLE TITLE HOLDER: _ of Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Countv 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 an 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 theapproved 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.
s
Si a bre o wrier/Le Co Factor as Agent for Owner Si ature of Contra or Holder
STATE OF FLORIDILL STATE OF FLOR
COUNTY OF "F 1 Yl COUNTY OFPIFA(tl-)
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisLW' of jlL fL� 20 Eby this 16 day of e a, 20 by
1AJ I(h() M ,el - 6f0d)11 S�W -
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(Name of person acknowledging) {Nae of personanowledging)
(Si nature of Notary Public-State of Florida) ( ' ature of Notary' /
Pu ' a
Public- of Flo )
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of identification Produced Type of Identifikation Produced..p.,�L.m
DANIELLE CARNEY
Commission No. r �+► `i � Commission NaPp- •'-, 1- tary Publif�p�e of Florida
A- )_4
•: Commtssion#FF 899125
* * ,:= My Comm.Ez int Jul 13,2019
My Comnt�slon F.on 4/1I B Ovao Notsy� .r-.
Revised 07/15/2014°" COMMUM No FF 96M
REVIEWS' FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE /
COMPLETE
.INITIALS