HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �^
' APB 4 2017
Building Permit Application
Planning and Development Services St. Lucie count,5,, ;_L
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR:
RO�P� f N:PR®VEPM NT L !i) r1l®N:
Address: r2Sy /NiE7rr7-m3 f3cy0 ��NS�iv, Ft, 3YRS7
Legal Description: f* co " o Sccrr��� a �io,ec�t
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Property Tax ID#: `-/ S" 0 Z Lot No-
Site Plan Name: Block No.
Project Name:
Setbacks Front "ram Back: Right Side: Left Side: _
rCEAILED DESC PTIO O,F WORK;
4
/Z 6 f3 y I +L- 0 1L' 15 i/N G- I0'Z-C/<
�CONS"T,�RU� CTI +� N IN�FOR�M yTl'®N:
Adaitional work to be pertormed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters )<Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /. O 04 . 0-0 Utilities: —Sewer —Septic Building Height:
Name L"rZY i- -TULI hlvci2e Name: Mv67!�-l�-'Y
Address: 8 3oo . Fti cvNC, Company: V, 4m-N ,a yzt iioc
City: C1 X Ci �% cAvrkn r��tate:_ Address: 1 `� C� IVY f3u 5►iv�s S n t__
Zip Code: L g P l IZ i Fax: City: T 6 AI 5 Stater,
Phone No. 01-9 0 Y -/ 2-ZS Zip Code: 3 `1 i 1;-1 Fax:_ -) 1 L'3 3 `t-`133
E-Mail: Phone No `7 -7 Z 3 3 `1— N 3 3
Fill in fee simple Title Holder on next page(if different E-Mail F M 9 9,l .S (8? A O t- . Gv i,►1
from the Owner listed above) State or County License Cie c. o 5-7 2-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI®N-L1EN' LAW I'NF®RfIUlAT1:70NR
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: JqA VL JZ_ V AL61-4.4 Name:
Address: 13 S J. c /vh1Z1irN7A owC- Address:
City: State: r- L-. City: State:
Zip: 7 K g e7 Phone -7 1— ?_ °f s 7 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: hone: 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 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.
Signature of Owner/Lessee/Contractor nt for Owner Signature of Contractor/License Holder
STATE OF FLO �� STATE COUNTOY OFORIDA c��
COUNTY OF
The r ng instrum t was ackno ledge�l before me The forges instrum t was a cnowledge fore me
thisa day of - k 0 k20=�y this ay of 20 ] y
r
i C� r4 I
(Name of person acknowledging) (Name of person acknowledging
Duvll-�I&A J al�_AtVL P�' V2
(Signature.-of ublic-State of Florida) (Signature of Nota Public-State of F orida)
ersonally K OR Produced Identification Personally K�`owrl, 4P[Qduced.I ratification
� RY p •i +
dentificatl Type of Ideri,ri;efiR Qs, ANGELA M HUFF
s Not Public-Sta
" UCe
Produced �'e•ia do of Florida
��SPRY pL�.•• ANGELA M HUFF
x a Notary Public-State of Florida mmission#FF 234730
n•; Commis' cl `%a; ;°P` M G° Expires Ma
Commission No. �,rt, g.v" JS@al)FF234730 Commission,No. R , lF eAJ19
.o >,• MY Comm.Expires May 77,2019. gh National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REV W REVIEW REVIEW REVIEW
DATE
RECEIVED 1 ZZ
DATE
COMPLETED
ev. 7/2014