HomeMy WebLinkAboutBuilding Permit Application i
ALL APP CABLE 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
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDI)'+IMOkOVEMENT LOCATION:
Address: C7( I Q 5E C�rn�(Q0 .�� F'laP- sT (,U ejc fC 3K95a
Legal Description: &&ZC QinLja S BA I. o2a 44-ka* PLC* L CAS act 4,36 (y1
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Property Tax ID#: oa.1q ^ �I Ll Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
Q_o.,m6v2� s u P Shy° r sue e OGi.�� k� c r
C � -Pa
CONSTRUCTION INFORMATION: .�.
apply:
Gas Tank Additionalworkto orme under this permit-c ec
11HVAC E]Gas Piping
_Shutters windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:J U 00 S . Ft.of First Floor;'
Cost of Construction:$I�. op Utilities: _Sewer[]Septic Building Height:l�
OWNERAESSEE: ONTRACTOR
'-Name ame: J1LPd,) '(IPY-TT -4--
Address:akp Ise ,<iwlplft }' Company:I a1'Qb7CPS'k16 s �
City: Stater- Address: 340 Pal%
Zip Code:3LigS a Fax• (,o(.-.17`t- 109 a City:tot STRI_ n Stater
Phone No, .33 -I Zip Code:
E-Mai . Phone No. 54pi
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: e L 8g
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
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:
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 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 inspectio . If you intend to obtain financing, consult with lender or an,attorney before
commencin work or cording our Noti ommencement.
Signa a of Owner/Less ont :rAgent for Owner Signature o ntractor/Lic a HolderTATE OF FL E OF FLO oCOUNTY �L1lX,C COUNTY OF
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The f r oing inst ment was acknowledged before me The f r oing ins ument was acknowledged before me
this day of E'.Iw s� 201a by this ay of 20[9'by
Name of pers n maki statement Name of per n making gatement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
—(Signature(A.,
of Notary Public-State of Florida) (Signa ure of N >:alcie#�
a� TARA LEA MATTHEWS
Commission No 1 1G3� (Seal) Commission No :'e MY 90MISSIO1$%id)3127632
?ors EXPIRES July 24.,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE /p
RECEIVED
DATE
COMPLETED 02
Rev.8/2/17 ..: '
TARA LEA MATTHEWS
, .
TARA LEA MATTHEWS MY COMMISSION#GG127632
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MY COMMISSION#GG127632 ;?dpti EXPIRES July 24,2021
July