HomeMy WebLinkAboutBuilding Permit Application J i
I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: Permit Number:LE Uemig 11 d 1~03 5 y
RECEIVED SEP 22 1017
BuildingA licati Permit pp on
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34992
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end df line tic- _ mom.}
-:PRO.POSED IMPROVEMENT.LO.CATION- .:. "
I . .
Address: Z - v,. . �— 1�RC . p .I / 2
i L
Legal Description: /U 1
Property Tax ID#: /3(n,!5, 1)060 Lot No.
Site Plan Name: All, 1_9 Block No.
Project Name: /v
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF WORK Y
I[
CONSTRUCTION INFORMATION.
Additional work to be nertormed under this permit—c ec a app y:
F]HVAC _Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: �j`7 2 S . Ft.of First Floors
g �
Cost of Construction:$ Utilities:D Sewer 0 Septic Building Height:
I
011VNE;R/LESSEE CONI'RACTOR4
Name aw> E Name: �b�P�l2 614C6N
Address: !l Company: eGil.� 1�P O��t
City: /L�/LC state: F Address: d 6w6Swm0,.0
Zip Code: y Q&z Fax: City: State:
Phone No. 772 - �(1?9 �n1 9 3 Zip Code: 33 ��7 Fax:
E-Mail: Phone No.,-/37/39957 5V 5ZY My
i
Fill in fee simple Title Holder on next page(if different E-Mail:��/ i�$!-/odteUw plA�uy eRG�uN�.
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTALCONSTWIDN Ll: LAW INFORMATION
rt ;r n
3a�, st_ _ 't M
DESIGNER/ENGINEER: _Not Applicable MORTGAGE CO P N _Not Applicable
Name: Name:
Address: Address:
City: State: City:
State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE LDER: _Not Applicable BONDING COMP�11�: �� Not Applicable
Name: Name: Qf
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 perimit 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 restriction's 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. j
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
commencLpmork or recording our Notice of Commencement.
Si ure of caner/Lessee/Contractor as Agent for Owner Si ture of Co dtor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 37-to C(e COUNTY OF I CGtG
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this�day of S(E A0T 20�by thisa day of )i'- zoAI by
966eg L $Qca�1
Name of person making statement Name of person making statement
Personally Known < OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pr9dTce Produced vt
q"
4TY/ -T6W
(Sign u f N blic-State of Florida (Signature of Notary ublic-State-of Florida)
t quo DEBORAH RA
Commission No. ram'• '•�' Commission No.��S (Seal
�S.hne 16,2r!'I
J r '
'I OF Fl�A Wdod TlNrd*UYYy3wftn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17