HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i - a_ s — Permit Number: t
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Building Permit Application
Planning and Development Services _
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772J
) 462-1553 Fax: (772) 462-1578 Commercial Residential
-_
PERMIT TYPE; C C e D (AT
PROPOSED IMPROVEMENT LOCATION:
Address: l071�o-ta�9le J.I S Vial. �ar,1. P6l-k Sf 3yg�s2
Property 3 p y Tax ID #• - y1q-S6t-5062T266 - q got No.- `i______.
Site Plan Name: T L oc i'" b FJJS - SAt�nP�per� �IJ� afl clock No. 15
Project Name: S Pl N 1l /A) [ iU 49 P-A--n L .6 n L
DETAILED DESCRIPTION OF Wi?RK: '
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t -
[ CONSTRUCTION INFORMATION:
Additio work to be performed under this permit -check all that apply:
zMechanical _ Gas Tank Gas Piping _ P g `Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
_ Windows/Doors
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: IjD,�� da% Utilities: —Sewer , Septic Building Height:
OWNER/LESSEE." C }I # I CTI R
�?J� one c °�S-i kmj� Name: F,qltl'IES-_ WILLIAJVIS
Address: a.o4� SC- 44Aati�'eCIA RA Company:A.6 cle A�(,4 r� nu C 01l 10
City: lk} S+. 'i State: Ir C_ Address: `7oi SE.
Zip Code: 3VR.S2 Fax:__ Op% city: �oc`�r ��. I.. &Um h CL Lk.P State: FL
Phone No. -11 of - S2 $ - 2'1q c} Zip Code: 3 $3 Fax: - N ( A
E-Mail: I�2beSe inno,C0M PhoneNoor -77-(oa(-iQSO
Fill in fee simple Title Holder on next page ( if different E-Mail0,(Z QtQ w n I k,; x- _r l C b rn
from the Owner listed above) State or County License- Q. C.
If value of construction is S2500 or mare_ a Mr'nuncn w^}.re -¢ r.,..._.. _--- -_ __ -- --
-- -- - - — 4Vit(i■i=11%=141elit m required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT O LIEN LAW WFORMATION-
DESIGNER/ENGINEER. V Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable i
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER; Not Applicable
Name:
BONDING COMPANY: ,Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVTT: 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 snakes 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 COWAENCENENT MAY RESULT IN YOUR PAYING
TWICE FOR V S TO YOUR PROPERTY_ A NOTICE OF CONNENCEiMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER Obi ATTORNEY BEFORE RECORDHWE Yni sea iunnrF nF srnsawFrurcuema "
ign of Owner/ Lessee/Contract as Agent for Owner
r ature of t or/Li er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF . S M L1i\,C' l e
COUNTY OF ZT L. UL' l ry
The forgoing instrument was acknowledged before me
this,z,l `day
The forgoing instrument was acknowledged before me
":�UACc
of Z-1-AA0_M Ake 20@-a-by
thlso ay of 20n—eAAby
_TawN ph;\1
' Z AfiWES U.) c LL i ll:�MS
Name of person makintsstatement.
Name of person makings tement.
Personally Known
V OR Produced Identification
Personally Known OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public
re of Notary Public-
-:° s ary Public -State o
YPL�% ALIC'IA HIGCF162303
Commission No.6Q
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Sion No. IRS '2°SP U8�_ F� Public -State of
=* *= Commission # GG
My Commission E=y'�c
*= Commission #
F�o�°` My CommissionGExS
ruary 9, 202
REVIEWS
FRONT
ZONING
SUPERVISOR
PLA S
VEGETATION
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SEA TURTLE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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