HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEVED
Building Permit Application OCT Z 4 2017
Planning and Development Services
Building and Code Regulation Division Fucie C untyG
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County; FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
Address: �� / S A- 'z-
Legal Description: tza n/nr �G h - P/1� 6�� - ��%/ L 0�-
Property Tax ID #: 70/ - 00" - D/10 —a
Site Plan Name: 174 rim r✓Wl' / U
Project Name:
Setbacks Front 0 / Back: Right Side: /D Left Side:
Lot No.13
Block No.
£DETAILED DESCRIPTION OF 1NOR3K e °'
s
lie-p1Ae e- 04-10d Jain#p,eJ 4007 -fie
e 0Ai5 Tr4, cl,'06/ a ,/) el ; 7-Q C 0M /DSO / e 1^OD�rN�
11HVAC IJ Gas Tank ❑Gas Piping
❑ Electric ❑ Plumbing SlpprSi-nklers
j"
LJ Shutters
❑ Generator
Total Sq. Ft of Construction: (?;\ / 'D S . Ft. of First Floor: _
00
Cost of Construction: $ a y o o — Utilities. _Sewer ❑Septic
❑ Windows/Doors
❑ Roof Roof pitch
Building Height:
OWNER/LESSEE
- �.x
f
�, �. �w�..� �.x
CONTRACTOR
Name / /) r ti u U-4
5 Dn/
Name:^
Address: ��/� �,' of
City: nn -f- 5 [iCr2
Zip Code: 5V9 5�— Fax:
�5�
State: /%L
Company:.Ay do
Address: 3 3 [S- 00 lyy» hl, .' of f
City: ' P tate:r--zZ,-
Phone No.
Zip Code: Fax: -3 Yo -
Phone No. 7 -
E-Mail:
Fill in fee simple Title Holder on next
page ( if different
E-Mail: $f ,Pj- PCta 00, /&Z
from the Owner listed above)
State or County License: u C
If value of construction is 57500 or more, a RELUKutu Notice oT commencement is requwreu.
SUPPLM NTAL
CaNSTRJTION I,IN I.AU1/ INFORMATION:
ff
DESIGNER/EN NEER: f� N�t Applicable
"
MORTGAGE COMPANY: Not Applicable
Name: a r r 4 U J� 2\
_
Name:
Address:
Address: 4eo V4 - r
City: U f A State:
City: State:
Zip: ?,,i a Mone F
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 nor -residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your propertNotice of Commencement must be recorded and poste on the jobsite
before the fir t inspection. If ou i tend to obtain financing, consult 'th lender or an at rn y before
commenci rk or recordi o r Notice of Commencem nt.
Signature of Owner/ Lessee/C ntr ctor as Agent for Owner
Signature of Contractor/License H der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ';�- I uG t
COUNTY OF S�- \,-kG, e.-
The forgoing instrurr1eq was acknowledged before me
1-7
The forgoing instrument was acknowledged before me
this 3 day of 0 c,�''DeW 20 l—t by
this 20 day of 20 by
Name of person making statement
Name of person making statement
Personally Known OR Produced Id
Personally Known OR Produced Identification
Type of Identification ^'
Type of Idtificati
S,1—
Produced `t � GEC �'-ci = '
Produced C'(.i
A
fq �
(Signs ure o Notary - Publi State of Florida) �� s
)
(Signature of Notary Public -State of FloridaAN
Commission Noe- ��2�311 (Seal) 6yy
mmission No.
MIGUEL N
I
MY COMMISSIO
REVIEWS
FRONT
ZONING
O
SUPERVI R
NS
VEGETATION
SEA T
-
RTI [ ��
EXPIRES Febriai
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
RE E
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
12, 2021