HomeMy WebLinkAboutApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number
J i _A
ONE
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 APPLICAT[ON FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Legal Description: er! }�S]de 117 iG
Property Tax ID #: Z32to- (OCD` Of I- OEM
Lot No. 1310 _
Site Plan Name: IWtS Frerr%"eZ _ M
Block No.
Project Name: 6ps Feirnm-AC2. _
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ln&dj1 l 14 q ` 4 c OA >,�-, 3 61L.0 3ales._
CONSTRUCTION INFORMATION:
Additional war to a performed under this permit -check all apply:
0HVAC Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
q0
L Electric l Plumbing Sprinklers Generator Roof
Roof pitch
Total Sq. Ft of Construction: SFt of Fifst Floor;
Of
Oseptic
L �15. Building Height:
Cost of Construction: $ Utilities; Sewer
OWNER/LESSEE:
CONTRACTOR:
Name % FeI e-L Name: _
4
Addressgb33Z, [s13�IIQ bf • Company:
City: Fl. Q1QYCe- State: I Address: j< •� • OY'&%4
A�]�- r
Zip Code:3�^{yCj -� City: or d+7�
� f
State:
Phone No29bf:240-- (p" 46 Tip Code:32_63 Fax;
E-Mail: Phone No. -10 -- q0
Fill in fee simple Title Holder on next page { if different E-Mali: r ►LAbb NL1 I
from the Owner listed above) State or County License:
I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
. t YVU
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address.
City: State: City: _ State:
Zip: _Phon= __ Zip._ _ Phone: _
FEE SIMPLE TITLE HOLDER: _ Not Applicable ; BONDING COMPANY: Not Applicable
Name: Nail-:-: _
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 mayrestrict 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 fender or an attorney before
commencing work or recordjng your Notice of Commencement.
T
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Signature of Owner! Lessee/Contractor as Agent for Owner 519gnature V Cont c or/License Holder
STATE OF FLORIj y STATE OF FLORIDA.
_W[
COUNTY Of �5T COUNTY OF_ !{ G
I
The forgoing inst ument was acknowledged before me ': The forgoing instru ent was acknowledged before me
this 3L.day of-3i: a2!%,V f � 20 22-by this _lL day offp ZO Z2.by
n own c4Gz t-r �I n n CYv_ F
Name of person making statement Name of perso eking statement
Personally Known OR Produced Identification Personally Known rOR Produced Identification
Type of Identification i Type of Identification
%y!5 e I Produced
Produced
(Signature of Notary Public - Scat f j _ ture of No Pu givIJREW BAUTEL
ANDR@70RAUTEL Y PiMY
Commission No.wall MMi55;i3 issian No. = SSION#GG3386Q2
?j� e ° Bonded Thru Nomry Public Unde wft
3t m �,Y EXPIRES:�EXPIRES: Mey Z9,z423r���44ded
Tttiru NouirNeni
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
+
COMPLETED
Rev. 8/2/17