HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:D�J`
' CEWED
Building Permit Application NQV J 4 1017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. ucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Generator
El
PROP®S`E® IMPR®VEMENT L®SIM-I®N:
Address: �z1 I I' A1�IC��" oIIvie (I�Q��,,l�(�� ��, � 1�, ' I ^,,�`I
Legal Description: I-�-GCf�:JOLJi r KI �"Pl� 13 !" �/- S� l XI 1tT- Q)
D
Property Tax ID.M A I R Lo- E)la- 002-0 — Doo- 2-3 Lot No.
Site Plan Name: /1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
n�-�
Svc i-I-�� - ) . vp► f -I c)nd `sr)o_r-1 I�cg m oduj_12 S
Plumbing
Sprinklers
LJ Shutters,
Generator
QWindows/Doors
E]Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $*,'!f`i - '" '' Utilities:Sewer �Septie;;;_.;;,, Building Heighta.+.;..
5
OWNERS/LESS'EE.
F f
C NTRACTOR s '`0"M 4
Name
I�YI�L%1y
Name:, 84:2!�ro��cl'Yl�
Address:1'49 I `Ci 0I
Company: � ��'�` C�
City:
Srt-ater,,
Address: l
ZipCode:,4ggl7 Fax:-1—Io1-3�.�-` '�
ty: �� AIII OP, Stater
PhoneNo.-r� �- -
��o
Co 3l .�4Q�I Fax:��o�i-g-�l�0-7
E-Mail
1"QI
one Nop.�
Fill in feimple Title Holder on next page ( if different
e s
E-M il: U !nI ( I
State or County License I o tO
from the Owner listed above)
IIf value of construction is $2500 or,more a`RECORgED Notice of Commencement is required.,fl"N _ I
e
SUPPLEMENTAL CONSTRUCTION LIEN L'A1N 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Contr ctor/License Holder
Signature of Own / Les s r/Contractor as Agent for Owner
STATE OF FLORID
STATE OF FLORID
I�
COUNTY OF
COUNTY OF— LP_A_e�
The instr m rA w s acknowledge efore me
The instru w s acknowled eg�ff re me
�ay
thi day of WA 20�y
thi of 201 yby
Name f Werna ingstatement
er onally KnowOR Produced Identification
Name o er n making statement
sonally Known OR Produced Identification
e of Identifi atI ^
Produced J�ov ! '
ype of Identificationq
Produced -6oal 6
dENNIFERCORSON
►s►Y P� .
JENNIFER
.®4+ JENNIFER CORSON
�1ppYA&�
001561192
(Signature' *PuNQrAt l:Qf9'0M)
(Signature of bli Yet®ct�ti 80li1021
�GFF��
�� o�� BondedTlw
oFFt �d�etMoWrYSenkei
BoadedTtwBudDetN�YServlces
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
�ogX JENNIFER C.ORSON ttA7 P, JENNIFER CORSON
,,...
.•�� Commis w # GG 156192
COmmisslon # GG 156192
ExPhsOcWbw30,2021
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