HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permi. Number: 1 ` oto 11
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VIES
Building Permit Application 7 ��r
Planning and Development Services �
Buildingand Code Regulation Division P�R;d;'sz i
9 St. Lucie C:�u`•'+-y�: ,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Qap eL
ORQPQSED INIPR0I EMENT LOtATIC N k
Address: 8000
Legal Description:
PE NS-e LrA
Property Tax ID #: 1301. W -1 .1)& 1. 0MI
Site Plan Name:
Lot No._
Block No.
Project Name: Poo L"
Setbacks Front 4 �a go Back: Right Side: 1� $$ - LeftSide: 111
C 0f4 Caren l E7 IVEC ,
Additional work to be pertormed under tnis permit— cnecK all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: F Sq. Ft. of First Floor:-
""
Cost of Construction: ��+i- er Utilities: _ Sew' Septic . Building Height:
Cost of Constructioin.�-
A
01NNER/LESSEE
CONTRACTOR.
Name it—ISEa-iLD iAt(Z:O4-1`0L�—
Name
Address: 000 V +�� �I d`I
Compari,y..
City: V-0 T V\E (L( C State: VL
Address: %I -; y ::�'
Zip Code: zlq LArl Fax: +.
City: 7 t' Y State:
Phone No. �i-166 `- 600 �;-Il q-7—
Zip Code: Fax: _
E-Mail: rluge-m, NDEZ,6 ho nl
hone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phon
NotlApplicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 com enced prior to the issuance of a permit.
tation that is St. Lucie County makes no represengranting 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 arq 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 intehd to obtain financing, consult with lender or an attorney before
commencing work or rec .ding your Notice of Commencement.
gnature of Owner/ Lessee/Contractor as gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA f • ., x Jx;4TATE
/1 Sj- - „ �:1:
S�'►n� ��
;1-�... - �i'FF'ELOF00 a
COUNTY OF
COUNTY OF
The for oing instrument was acknowledg d before me
The forgoing instrument was acknowledged before me
this- +'dayofMoUe0)h21 .20I7 by
this day of 20_ by
Fl I i �Q4o P PrhoA CfZ I
Name of person making statement.
Name of person making statement.
Personally Known OR Produced dentification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced 4' .a, Spa Q \1CrS �i �ig
Produced
DEL
c10T.g9.9'�1�.
(Signature of Notary Public- State Implresi m
a March 28, N
(Signature of Notary Public- State of Florida) '
2020 j
Commission No. FF9r�(,Zaq Zoa 6229••,
Commission No. (Seal)
00 •��S Z.
REVIEWS
FRONT
ZONIN9......
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
y
.
DATE
COMPLETED
Rev.8/2/17 I % `