HomeMy WebLinkAboutpermit app - SchochALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1-ta) -2)N Permit Number:
- 13 -
s
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential .
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: O
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Va r'+
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P Z- 3g
Z
Legal Description:
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t d o I� Jvt'
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Ca f d rn
3 ` ZZ.0
Property Tax ID#: 3111 - I0 - 0/sZ-- 000 --
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No. / U
Block No. IS -
adaitional work to be pertormed
HVAG GasTank
under this permit- check alln=rs
❑Gas Piping
�Windaws/Doors
Electric ❑ Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ �qW_j - 3 0 Utilities: Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _kJ1
Name: r_cs l 41 S : o r-s
Company:���
Address: C] 149 G
City: S-G-/ _ State: �L
Zip Cod e:i- i 5-2 Fax:
Phone Na.7`7 2_ -S-3 2 - ®63 ?
Address:
City: t—f' _ State-R_
Zip Code;3H 9 L Fax:
Phone No. ` Z " ? 1- Z.�
_
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: i_r160+ � Ie�S , C ►�h
State or County License: 5 L L
mil- 1 0
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required. '
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: 'e�Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
BONDING COMPANY: of Applicable
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORI A
COUNTY OF c,C,-'.f�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this_? L day of<IC... 20 26 11 by
Name of person making statement.
Personally Known i, OR Produced Identification
Type of Identification Produced
(Signs re of No aryPu lic- State of Florida)
Y
JOS>rPH BA01Nl
;'
Commission No.4l (Seal)
*_ MY COMMISSIOt1 # GGJ274212IXPIRES. Noviiner.21TVN�ryPuWU
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21