HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "d1�1,1 Permit Number:
RECEIVED AN 171017
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
'Pik to P,R°VEM'EN,TL®CATION'e�� `�I ON
Address: 5503 14 & Yr.
Legal Description: A-wn&gi Qayex E,51oc-&N Uvii's-cog'&1✓, 23 Lo-4-Aa,
Property Tax ID #: Lot No. 4a
Site Plan Name: Block No. 7_1
Project Name:
Setbacks Front Back: Right Side: Left Side:
2evno�e e wfin� bti�v<y (� Yoa�Ay 9-1.� 9 t,7sd�1� o, z6g�i sv c tie Y'm y -CyA" ov&-
11 Electric 0 Plumbing []Sprinklers
1 Generator
Total Sq. Ft of Construction: 31D0 S Ft. of First Floor:
Cost of Construction: $ IQ. X0b Utilities:[]Sewer OSeptic
F]Roof Roof pitch
�6S
Building Height: I2�
OWNeER%LESSEE � ��9
C®N.fk7,
Name_ KID e,hIoj tj
Name: (1%tV',k4" LA.9-4
Address: 560) 5cc+9Afc. br.
Company: Itnc.
City: �g(&/W_ State: fL
Address: $12 st- Cmaco,1 �✓L
Zip Code: '14U a Fax: —
City: 51QQYV Stater
Phone No. —
Zip Code: 3Aq`1A Fax: -I�Yt rlb3-3
Phone No.'III-- "643-4663
E-Mail: EA4umv�&4 (0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CG1i13367
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION, LIEN, LAW IN;FORIVIYATION,
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.
ignature wn Contractor as Agent for Owner
S gnature o ontractor License Holder
STATE OF FLORIDA
COUNTY OF ;We�MA7
STATE OF FLORIDA
COUNTY OF
The forgoing instru Went was acknowledged before me
this / 7 day of 20_�7 by
The forgoing instru ent was ac nowledged before me
this /7 day of 20� by
wGA2do I./re/
'61da rya ZAZA
Name of person making statement
Name of person making statement
Personally Known _) OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
_A""- (,ln' Zc�iu7
Produced /�
&ell_444 4,/��w eaw
(Signature of Notary yublic7r t"R A?19 1ano
�'� NOTARY PUBLIC II��°'p
Commission NooQ � OF FL DA
Comm# GG126275
G. VCR
(Signature of Notary �i461'�aMgd)PJJ3tr&Ja )
Y� NOTARY PUBLIC
Commissa °�STALORIDA(Seal)
Comm# GG126275
'si �� 021
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Rev. 8/2/17