HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
KovEiVCENTIOCATICIN
`;PRQROSE{
Lta 3
Address:
`,
_
l_3S.[� ] tM�txi k sc-,��
Legal Description:
2 2 �' 00) t 0) - 0) 1 0 I Lot No.
Property Tax ID #:
^
bou r- o U-k 1T1725 Block No.
Site Plan Name:1 ,,.,`�... 1 I1�
C
L ` I�-Q"'��
Project Name: v�-� � � u�r-4u
Setbacks Front Back: Right Side: Left Side: •J
s
:oft
CCY�PCfi —flbr S c-'O
�,� 2.�is
" Additionalwor to e e orme un ert ispermi -c ec a appy:
[]Wind ws7Doors�
❑HVAC Gas Tank ❑Gas Piping _Shutters
❑Generator Roof
pitch
❑Electric Plumbing ❑Sprinklers Roof I� `t'"
'
Total Sq. Ft of Construction: �UP S �Ft. of First Floor:
a v ❑Septic Building Height:
Cost of Construction: $ Utilities.. Sewer
�� �-S ,
CONTdiAMR
Name(1^,.c.� _ + YXbw'&JX U� I =e.S
Name: `Fi�O
Address:(Q 3'S / fIr
Company:
Address:.���.
City: IG✓L2 Stat :_
Statr=:
Zip Code: C �Cl Fax:17d- {off} ,3(�(�
city: Ve'C') -lam
—T'1Li•L,)L-il�
Phone No. a $S
Zip Cade: 5LZGLLQf0 Fax:
Phone No.rr-Yi —1C>oA �Lk0��('K�
IP
ell�0 �GY"�`r
-GOi'1'9
E-Mail: —\��
Fill in fee imple Title Holder on next page ( if different
E-Mail: 4' A. RP:')'r (1rrY CS��• CAM
from the Owner listed above)
State or County License: r f"� ► 32"1g"� 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
M
,o
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip; Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Address:
City: `t`y
Zip: Phone: Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit>u uu List --•• ---••_._____-
I certify that no work or Installation has commenced prior to the issuance of a permit.
St. Lucle County makes noVVrepresentation that is granting a permit will authorize the permit holder to build the subject structure
structure. Pleasse conisultwithpyolurHome Home Associ Association andrreviewyyour deed for any restri that
onsawhich maor
aprohibit such
In consideration of the granting of this requested permit, 1 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, cot sult with lender or an attorney before
commencing:work or rec n our Notice of Commence
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa a of Con c 'sQnse Holder
STATE OF FLORIDA
STATE OF FLORID
��
COUNTY OF _ 11-malcn R"ve-�
COUNTY OF
The f,Qp�r�going inst ment was acknowledged before me
The �fo,,rpp��rrpp��instrument was acknowledgg��d�� before me
thi42 ayof /1I 20L1 by
tf7iS]�_dayof 20�1 b
ll
eking
�ohN
Name of pef�on� Ing statement
Personally Know>ta�_OR Produced Identification
me of pe, son statement
Person II Known OR Produced Identification _
Type of Identification
Type of entification
Produced
Produced
(Signature of No I NOtary PubliC sts 01 FlaNde
(Signature of Not y;Pptilj�-State o L9 A ETT
.,q,. Notary Public -jtat of Florida
;; iM .rs; Comm.:Eior��$iS
$ Melissa COle, L`FB06
Commission N0. omm.us�n Ha
Commission No. :•: r. �.' fy Comm. Expires Sep 28, 2022
p 28, 2
—.
ah @zpiroa Oa/t4/2023
Joreed through National Notary Aean.
-
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SE EVIEW
MANGROVE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17