HomeMy WebLinkAboutBuilding Permit Application P
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ', v�as Permit Number: \101�- 63'j a
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RCI SEP261017
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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
PRQPQSED [MPRQUEMENT LOCATIQN
Address: 910 Dn ?aA sk- Lue1e. L Z
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Legal Description: rack & S
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Property Tax ID#: 3 419 —:52-07 0620 — 000—g 1 Lot No. !`l
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION Q iNOEtK
RQftoW- layer Rotk f v&On aAA or ibrch C60A -Cq_0w_1 10vo/Flai /1?60�
tic-A&:1 d@c►6ej . j4nst^k% � ds:e *.�-
�--kvtd%�yl � Pla� rook. IT�eth 11ew At4^1 fv01:., ovar 167t Sr`•,jS or, �i�cMed
CQNSTRUCTIQIU INFORMATION.; _s
.. a:. ,_tea�� a.,_� �. , , : „, . �. a.�. rv, ,
Additional workto a er orme un er t is permit-c ec a apply:
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HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing OSprinklers ❑Generator Roof 3 �L Roof pitch
Total Sq. Ft of Construction: ?e7dQ S . Ft. of First Floor: j_7 42
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Cost of Construction:$ �'.S,y5 Utilities: _Sewer❑Septic Building Height:
QWIVER%LESSEE CQNTRACTQR
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Name a or S Name:
Address: �e2"]y� � _ Lance Company:
City: Jt0%_5j-r1 beach State:jar Address:
Zip Code: 3Ng57 Fax: City: State:
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Phone No. 77Z— a d 1 0095 Zip Code: !Fax:
E-Mail: 4':0'vinr %ow'sp-NN0lac Sou .nw-t- Phone No.
Fill in fee simple Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUf?PLEf1l1ENTAL CQNSTRUCTION LI£6 LAW INF(}RMATfON
DESIGNER/ENGINEER: Not Applicable _MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 anothelr 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.
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Signatur of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF :�)r- LUC '0t COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this• day of S 12011 by this day of 20_ by
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
Produced 1� L, Produced
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(Signature of Notary Pu li � FloricW-MNA MARIE GIVENS (Signature of Notary Public-State'of Florida )
�; *z MY COMMISSION#GG 022023
Commission No. �5 J�f :December16,2020 Commission No. (Seal)
Bon JP
Thru Notary Public Underwriters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE j
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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