HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICAB pINF
O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Q
Date: ' ! Permit Number: I� " 04Y -1
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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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end if line
P'FtOPOSED IIVIPR01/EMEIVT LQCATION
Address: 5~57 (0� I<oblegard P—cl Cf;;+ �e✓��, (G 34g5-f
Legal Description: 3 7 3� N e� �� C1� SW Vcl IGSS AJ tfT r{.• awWej ��ss
04e) C(Q) (02 ISSa - lgyl)
Property Tax ID#: 1361 -311- 000 1 000 Lot No.
Site Plan Name: /�_ Block No.
Project Name: 1 lu yy" 5d n
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK A t ,, x
� hw•r� �p;b�rv�� rva�'r^_'C �.►�S'1rrA1 n,ev.) uhdee toll +�
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C�ac�sso✓y Vv+e s 0,l new Y►1e a1 PG,Ke�S.
CO_NSTRUCTIO`N INFORMATION "
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Additional work to be nertormed un er t is permit-c ec a apply: I�
❑HVAC Gas Tank Gas Piping _El Shutters ndows Doors
❑ p g I ❑ . /
❑Electric ❑ Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: '5'1dD S . Ft.of First Floor:
Cost of Construction:$ f 7, dad Utilities: Sewer❑ISeptic Building Height: 1 y
OWNER%LESSEE I .;
CONTRACTOR•
Name IMiC4�ac� l�. qu, Dic d"'_T tk"V rC-6mn Name: �SUGYi -
Address:-65-(v3 Ieo6Ile gara u%• Company:ia a k 0Fnti S SEemS S
City: w Pee y-il State: Address: 3a0i G-e aey& i Cam.
Zip Code: 3 q a S f Fax:`t�� z &a 3 3 City: $�uc..diC .1 State: 115(-
Phone No. 1 1 Z -B"1 1 Old 30 Zip Code: 3`tgq-1 Fax: '1? 2*To 33
E-Mail: Phone No. ? I}Sr'1 Z gb-%c�
Fill in fee simple Title Holder on next page( if different E-Mail: cA lerzq ta)wlroo0 S Sktrns, *Ve _
from the Owner listed above) State or ounty License: CCc 1330.7'W
If value of construction is$2500 or more,a RECORDED Notice of Commencement is irequired.
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SUPPLEMENTAL CONSTRUCTION LIEN L"AW INFORMATIOaN
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMIPANY: I_Not Applicable
Name: Name:
Address: Address: it
City: State: City: I State:
Zip: Phone Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: 1
City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the word 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 rpay 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.
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The following building permit applications are exempt from undergoing a full concurrenIcy review: roo I 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
commencing work or reS
oMingour Notice of Commencement.
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=ATE
f Owner/Lessee/Contr r geri or Owner Sign a of Contra' r/Licen o er
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FLORIDA STATE OFF 0 \
COUNTY OF �APcu�1 COUNTYt��
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The forging instrument was acknowledged before me The forgoing instrument was acknowledged efore me
this �Jay of ,201 by this day of 201flby
Name of r on making statement Name of er o makings tatement
Personally Known OR Produced Identification Personally Know OR Produced Identification
Type of Identification Type of Identificatii n
Produced Produced
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(Signature of Notary Publi State of Florida ) (Signature of Notary Pu i State of Florida)
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Co m m g9p o. eal) Com al)
;, R., I: BONNIE LO
ONNIE ITT VITT
:VA MY COMMISSION#GG143436 ;•= MY COMMISSION#GG143436
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R SUPERVISOR PLA MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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