HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'a5��1 Permit Number: 11d���3�
RECEIV 2012
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax: (772)46271578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
APROFPOSE}DIIVIPROVEMENTLOCAl"IQ.N'
Address: 3�SQ 11 Mile 120Ptn i Fr- _PtWe_e ,''i) 3-1 SS/S +
Legal Description: 33 35 3Q 'fiI er PAAX-OF W 1/2 ot- N(U) IN LYG Nal ar-T-fw tutlr' �,'K(
AJdBanal J?S.W (.JgJ?q A-c.) tor 21q -WC-7 -517--70lI; 371.K -2y731
Property Tax ID#: (Srid) Lot No.
Site Plan Name: Ai\m-L R. CP4-Wvf\ i Block No.
Project Name: eiNf 1 0r,
Setbacks Front _ Back: Right Side: Left Side:
p �
'' _-^..:` .�_:,';i2+ __s.,.._c `�" S�_�;u ...fir tK �....z..aw .y� ' ..ice�_ �..,'��s �•z., ...��. F � � �_„chime
73ee 500�aI10 1 G P fan K .a &-i ,bu rq
qaa r Iku— -�v ft-ed gen160-rrd- -
'�.',� r t�itiona wor to e e orme un er t is permit—cieck all apply:
�/ �HVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors
I
Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
i
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ��� •�� Utilities Sewer Septic Building Height:
3j r :.i
L_0;1NfNER%LESSEE` ; ` ¢ _ 4C®NTRACTOR �, Y
�:_. ':�., ' y� _.a..-n _ r �....`?..-.� w�;.s s >P c+_..._v:•,::'T+....,`:'T.br.:.. a.�........�,.?....e s..`�....w La-> �.r-r � .I� rt
Name . C l Name: kn Y%'
Address: 3 59 Mdaoeood Company: _ 1I4 �
City: Pt-e-lr e- state: T/ Addre
Zip Code: 11i(5 Fax: Ill/A City: U f<j �1 State: t
Phone No. 714 370- 1931 Zip Code: �'3 WT Fax:_-77e1.'�S
E-Mail: I,JCOrI{e,0 � L( & f40ft- 1,COIV) Phone No. .g 5`(oc�
?-74- 4 9 6 v
Fill in fee simple Title Holder on next page(if different E-Mail: C� -a 0' dorn,� (Jd"IC�e ,
from the Owner listed above) P
r County License:
I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1
I
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: I
City: State: City: 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:
I
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the workland installation as indicated.
I certify that no work or installation has commenced prior to the issuanc&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 anlattorney before
commencing work or recording our Notice of Commencement.
i I
Signature of 0 er/Lessee/Contractor as Agent for Owner Sign re of Con actor/License Hol der
STATE OF FLORIDA �. STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent Incas a knowledged before me The or oing instr risen was acknowledged before me
this day of 20/7 by thV day of 2 20/7 by
Nam of person making statement Nam of per, on making statement
Personally Known X OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(
i
( gn ure of Notary Public-State of Florida) j(!' �nure of NotaryPublic-State of Florida7� Se I (r-®��C� 7� of 3 ( "4 omsion No. )''
mmission No. � (S� ;.
Nb c glatG°t FlpjOd o I vuu c Spate psrac
Pu 1i o36 �;""'i, tJota•v GG o2
2`oyµ„,,.., ,,' C'°mmiss� Vices sec �5�, =Z, `, ��•: G°m m,ExP<<es o�aly,p5s;
REVIEWS F Q T�: N� Ex N �d;t '- PLANS VEGETATI
CO a;32 thsou9 W REVIEW REVIEW -- ��7IF da hl EW
DATE
RECEIVED j
DATE
COMPLETED
Rev.8/2/17
i
i