HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �( 1
Date: Permit Number:
M Building Permit Application
MAY i 1 f.ril
Planning and Development Services PER,1v1 � •..
Building and Code Regulation Division St. Lucie C,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: Not) C,owe-, eeg LaAe
Legal Description: Lot- y , Ca4y OZAe SIB
Property Tax ID#: �j�}D� • 't vl• DOD�•000 Lot No.
Site Plan Name: �{ Block No.
Project Name: �ar.{Cibb
Setbacks Front 2-C2' Back: Right Side: 10 Left Side:
a OR -
P M 00 OR
Fret. b,r; 14' x ;�0' S hed pr) WuCu fal P[0�' M .
Additional work to a performed 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: `l 20 Sq. Ft. of First Floor:
Cost of Construction: $ W•0o Utilities: _Sewer _Septic Building Height:
Name Q 2 Name: 1 ,,lL�
Address: Zoo of Le) Company: S+ � ayi J-Ac-
City: ►r+ Rprce State: _ Address: b001 S G
Zip Code: (3LI199 Fax: ff��2 IPT,cog City: IPr�'CI State:
Phone No. 012•)31D•0 J Zip Code: � �gZ Fax: ��2 `t }•Dd
E-Mail: Phone No 1�,$
Fill in fee simple Title Holder on next page ( if different E-Mail " XzOg/�/?i(,rl� 0
from the Owner listed above) State or County License O(7 C 1512Cj��
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: q, AJ, —S_Ilr_ Name:
Address: (Z Address:
City: UZ State: City: State:
Zip: Phone 2 1' s• 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 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..(1", 4 0 IAd �J.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF t'lorc ST Lwc COUNTY OF t' (at i d,\ 'Z-a Lk4,�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this V7 day of M.M , 20_a by this t'l day of NA4.a , 20 t7 by
1�l.L1n�I I roa,hj CJk&r.i Rr.Line,I WtbolLr4z"
(Name of person acknowledging) (Name of person acknowledgin )
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification rot�R:P�ec Type of Identificati
Produced CATHERINETHORNTON Produced �"��°��+ CATHE
* * ION#FF 942003 * * Y COMMISSION#FF 942003
EXPIRES:J� 6,2020 Commission Nc 9 r EXPIRES:January 26,2*al)
Commission No. oFFL °P edThruK Senores ;Eu ��udget Notary ServKes
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.