HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE M- MPLETED FOR APPLICATION TO BE ACCEPTED
Date: /a' 2*17 Permit Number:
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
PROPOSED IMPROVEMENT LOCATION:
Address: / D) A 6 JTl_-P_J7 A/ IJ 12.•D �o;-�Sf `e FL 3 4e%8 3
Legal Description: _ _ 2i VCV-9. P,*K - UAJ/'7- 9 - 9AAJ- 8 L,K 73 l..oT l9 rtnw
Property Tax ID #: 3 `-/ 19- 5&5- o U,2S- 000-z Lot No. ) 9
Site Plan Name: S m-'4-k Block No.
Project Name: >4 T-4
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove eP` *,j dame,5ed �. a door gen,'rI 5"fIcc, +)n5.
�n+ �k� G�K-cL ►^ 'l ,e4 0r r y a l ( ,,s,L`- nc nec ,h a,+mil. P (a ws
CONSTRUCTION INFORMATION:
Additions I work to be performed under this permit— check a am) v:
11HVAC u Gas Tank Gas Piping LEI Shutters a Windows/Doors
11 Electric 0 Plumbing O Sprinklers E] Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ )_3 7 Utilities
aro
: _ Sewer El Septic Building Height:
OWNER/LESSE
CONTRACTOR:
'Name. vIC, ram`. 1
i ",,~
..�<:as
uName::...,,•
�v�=;�Gc'6�J
Address:, e2 i:.d:, �Ct.
/_
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Com an ^ J �i i tc s
P y ; . 0,, ��Cd la
cfib
-City:----
State:
City:
(—r ilele c
State: Pe_
Zip Code: Fax:
Phone No. -77.2- 6Y - 8334
Zip Code:
Phone No.
-7 55 2 - Fax: 7'7, `/� &
% %,�L �(--S-2_4S3Y �5)4-b2,ff
E-Mail• Coco S 4 1 Va.r 1I Lo,
Fill in fee simple Title Holder on next page ( ilqifferent
E-Mail:
v! �w l41
State or County License:
G yzJ
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEi LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Ap MORTGAGE COMPANY: Not Applicable
Iplicable _
Name: kidt ikenarJ -Art k-'+ectoyi TYI-C • Name:
Address: 80(, Ve(aware AK I Address:
City: Pr ?,,'y,rce State: FL_ City: State:
Zip: 3c(S.sG Phone 77,2_ 7S(/ Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
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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 commen5ed 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
is in Home Owners Association bylaws that
which conflict with any applicable rules, or and covenants 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 1 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 con currency' 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.
Sign ure of Owner/ e s ontractor as Agent for Owne
Signat of Contractor/ ense Holder
ST E OF FLORID
STATE OF FLORIDA
COUNTY OF 77- Lk,CfW
COUNTY OF ST L-tcCi
forgoing bl fore
The forgoing instrument was acknowledged before me
The instrument was acknowledged me
this,M day of 0GT06EI2- ,2017 by
this2,1� dayof �C7D�EJ2 ,20I% by
6- tfN J A-'6 BS
3 0 t4A) Jj-ca 6,3
Name of person aking statement I
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type'of Identification
Type of Identification
Produced
Produced
j
EVENS
a 00M7g
of Notary Pub ic- Sta
` ;' PATRfCIA STEV
n No. D�3%( :: ( IAOMMISSION
(Signature of Notary Public- State of on S
b�. PATRICIA
Commission No. �i �S a1� ,My COMMISSION
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CMG # GGO
3
"N� ES September
'�I EXPIRES
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19, 2020
" ;?!, ,° EXPIRES Se to
P tuber 19,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
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Rev. 8/2/17