HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to al /17 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 j
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED tIVIP.ROVEMENT,.L'OCATIbN
Address: 5011 < &u ,✓ (X h / ),f. f4. A,- de- i . 1%/ 3qc? �2-
Legal Description: l eid i -n Aye r Fs 4cd eS " I;/ nti) i +l 05
1.7 161S LS -L 2-,f (MCV 31-l/02S J (Of 3`6g2-?s'sy
Property Tax ID #: L �, -G2 Zi - (�- Lot No.
Site Plan Name: % i°► Block No, c�2
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED bESCRLPTION.OF WORK. `
/�C,Pl �c.,,nd ry Leo, w� �) v",r ��, ,�a� i�S4cy
Wlr,54e ���C� �. Vn d y $I'� h� �' f'G r� �'l �eS� 1.✓e,�-�r ,il�.z, a �Y
'CONSTRUCTION INFORMATION
Additional work to be Derformed under tispermit-c ec a appy:
❑HVAC 1:1GasTank Gas Piping LJ Shutters ❑.Windows/Doors
11 Electric 12 Plumbing ,) Sprinklers FIGenerator Q Roof Roof pitch
Total Sq. Ft of Construction: 2 Ji '7 S . Ft. of First Floor: 2 / / L')
Cost of Construction: $ Utilities: Sewer Septic Building Height:
OWNER/LESSEE: .':`
CONTRACTOR.:
Name Sr i�/�
Name: Pey,,Yn Sr, v-42xo3-
Address: SO7�f S�'/l�t�r%-�it C�/
Company:_S, E,fi10 h
J
City: - /�'rt r-f /�� •e .-r e. State: /"L
Address: >yS<X S wI"- r 7 c!
VG J
Zip Code: 3 J/5' fs.a Fax:
City: J9at1 54-) Lye-,% je
Stater
Phone No.Z 77.---J Z S2-S 4cRK
Zip Code: 31i'IS3 Fax:
E-Mail:
Phone No. 77 Z ~ -0a iq
Fill in fee simple Title Holder on next page (if different
E-Mail: 4+ 150 /i
J ee,4erz 6e111
from the Owner listed above)
State or County License: /5/2 1�
2920 7
it value of construction is �iZWU or more, a RECORDED Notice of Commencement is required.
SUP PLEMENTALCONSTRUCTION
LIEN LAW'INFORNIATION ;
a,..... �.. �,..,.au:,.. ,
,
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
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 tM jobsite
before the first inspection. If you intend to obtain financing, consult with lender pr/an attor e 'efore
.commencing work or recordine vour Notice of Commencement. I
Signature of Owner/ Lessee Contracto as Agent for Owner
Signature of Contractor cense Holder
STATE OF FLORIDA
�_
STATE OF FLORIDA �{- l
(
COUNTY OFL--CCU
COUNTY OF I
The forgoing instrument was acknowledged before me
The r,40g inst nt as efore me
thisday of 0 Cao L,, ✓ 20Z2by
thi day of V� 20,"by
Name of pers making statement
Name of �ef�on•m king statement
Personally Know OR Produced Identification
Personally Known /` OR Produced Identification
Type of Identific ti n
Type of Identification
Produced
Pro ed
(Signature of Notary Pu lic- State of Florida)
(Signature of otary
u i -
,,,,. r-=J SON
Commission No. (Seal)
Commission No.
GG 022000
;tt • EXPIRES: September 11, 2020
Thru Nc Pu* undam t fs;
Banded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17