HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUi ATtON To BE ACCEPTED
J2/l oaU Permit Number:
Date:
ti - J
I am• _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierre FL 34982 rYteFClal Residential
rtl
Phone: (772)462-1553 Fax:(772)462-1578 Co
E
IT APPLICATION FOR: To Select from dnopbox,CN&arroyo at the end of line
OSED IMPROVEMENT LOCATION: /� p
Address: 10—TX77 V'SS
Legal Description: 7f 4ScrtL CiJGtSr / ��i(kZ 5tiC ok 3�dy'l?�J7
Property Tax ID#: r�o� - ' bC Lot No_ !
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Leh Side:
DETAILED DESCRIPTION OF WORK:
11 "from �t1►'�1 wi�A ne•,) lJ :t� C•f✓m;nu.n, ne4•-) a �o no See-vnL sc✓un
.i,n,F f�-frc� �Y.S L�,iJSh'nS roo F CL�aI cow re fc Ela6 b
CONSTRUCTION INFORMATION:
iLona war to o un er t is permit—check a apply:
LJHVAC �Gas Tank ❑C,as Piping _Shutters Windows/Doors
13 Electric Plumbing oSprinklers Generator Roof Roof pitch
Qt a
Total Sq_Ft of Construction:� / Ft_of First Floor-
Costof Construction:$ 7� Utilities: Sewer L�Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Pnul 4 8ak Logo firnaS Name: t4 mn"er
Address: J-D017q reSS I) a aL Company:&k'S %1 f C/tCiun n�
City: L L2 ca z— State: �_ Address: .er n� /I a,brit/
Zip Code:3yc7 9-2 Fax: City:/�ss� �1. P';a rc e State:
Phone No. Zip Code: 3el5&a Fax:
E-Mail:/SlnQflQ 3loi{ (�MAII • SUM_ Phone No-fl� T��7a Kok
Tide in fee simple e Holder on next page(iffe different E-Mail: cc�F i n�S�SG1 �&h1 n�L. �a►'t"
from the Owner listed above) State or County License: 3D3S/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: Pkvk tlikiQ,
Address: Address:
City: State: City: f(W- IAuf/ State: fJs
Zip: Phone Zip: D%'05l Phone:
FEE SIMPLE TITLE HOLDER: Nat Applicable BONDING COMPANY: C 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 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 Commencernerrt 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.
Si�ture of Owner/Lessee/Contractor as Agent for Owner Signature o ContractorA icense Holder
STATE OF FLORIDA, ti�� I OUNTY OFE OF O l d-, Gt LC,y~>O
RIDA
COUNTY OF ��-
The forgoing in mint was acknowledged before me The for omg instrument was acknowledged before me
thisi day of 20ZQ by this day of C � 2020 by
Name of pe on making statement Name of person making statement
Personally Known OR Produced Identification Personally Known-19—OR Produced identification
Type of Identification Type of Identification
Produced Produced \ �J
(Signature of Not (Signature of Notary Public-State of Florida)
t'.A'toNotary Public State Fionda
Commission Nona mm Commission No�omm on 328515ola Public Slate of FI
as 0Ert2/2o23 Deana M Dailey J
} MY Commiwon GG 32651 a
REVIEWS FRONT ZONING SUPERVISOR t PLANS VEGETATION i aM1 I 'MVVrill
COUNTER , REVIEW REVIEW i REVIEW REVIEW REVIEW 11 REVIEW
DATE
RECEIVED
DATE '
COMPLETED _ _
Rev.8/2/17