HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 9INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I ,,
Date 9 l Permit Number: l!/
O
Building Permit Application MAR 2 7 2017
Planning and Development Services PER;V1ITTiNG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential J
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED.IMPROVEMENT-LOCATION
Address: tA)f S+ V I rQ in I a )DP-. -mil'+ -Rf f C2, c 101
Legal Description:
Property Tax ID#: J-f 0'3 ���� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF WORK:- ,u
itGMS�r t4-)S t) � din � .. ..,,...
��t- l��� re�l 4% �n , (n N- 90L
rbbb-� tJ ►� > 5i';c k rn ode F►cd bi ►► Y, .
CONSTRUCTION INFORMATION
Additional work to be nerformed under this permit-check all apply:
0HVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers a Generator OrR o o f Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ T,_71 l_r Utilities: Sewer OSeptic Building Height:
OW:N ER/LESSEE CONTRACTOR
Name e vik Pe Name: rF
Address:1505-0 1,-� V-, 1,01a Company: 2+ Lj_�OA't- Q Ok_�,(1!q
City: ' -�f- P;e r-Ge State: Address: 160 S:J SwO M�actd l 6 y,4
Zip Code: 34gK1 Fax: City: e o L- S+ Gc iG�-4e State:—k-
Phone No. rl 9 of -d L-I O — Ix s'33 Zip Code:-3LtT&-'q Fax:
E-Mail: e i,n YonnA,( C 13IM0 + • ► (,+ Phone No. '?22- 3 4 L1- "I I°I 3
Fill in fee simple Title Holder on next page(if different E-Mail: Si I u Gee -oz F, @z- aX)Oz�, •e.�
from the Owner listed above) State or County License:
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:
Address: Address:
City: t 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:
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 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 r rcling your Notice of Commencement.
A//,f,�I- P_Cot'��dn . - U, s
Signature of Owner/Lessee/Contract r a Agent for Owner Signate4f bonfattor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF S-� t-+.t c��- COUNTY OF S� ��
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this;2.3 day of 20 nby this day of MOrc-'- ,20 19 by
ze Je_W_rq�4 0�_=�)n
(Name of person acknowledgin (Name of person acki owledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced -IC bL_ Type of Identification Produced
Commission No. I -- - - Commission No.PMiNSTANC'-`�I � UL.X
ONIb1TAN02 PROUL YY ; - MY COMMISSIO #F 160517
7 XPIRES September 16,201B
° EXPIRES September 18,201.8 (407)395-0153
� FlordallotaryServke.com
Revised 07/15/20
�., ,
( 7)398 0153 FlondeNota 9ervlca•com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE /
COMPLETE
INITIALS