HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET—,"OR APPLICATION TO BE ACCEPTED
Date: �� 'd Permit Number:
Building Permit Applicatio Nov Z 9 2017
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 X
PERMIT APPLICATION FOR: gb �,- a � \ J-t W 0"i
Address: 351 N o_rLe'1 •ji Iy8 P09-1- PI MC E , ,K&' t2-1 DA
Legal Descriptiion:n'Tl,e tA5+ t1q.5 Fee.+ oP L+ q aAat C 11 OF G07•5 10_ -i lT, DWCk- 3, RSA Mwmnn Su�,�l�yisio�l,
9CLaro� ril c, ►` JriT giGF¢dF. 9S i'�Lerc��ul i %�%y�Qcv� �� ��s�.,� deQ the �+�liZ 1t?eeet .f ��r i 1.1[G� eawsw. -> &je,D10
Property Tax ID #: �jt(��_ �7�5'�b5 I - cJoO/q _Lot No. l� 0 1�/2
Site Plan Name: Block No.
Project Name: Jetfirey Kr 7TTq Q5 i cue A c _
Setbacks Front Back: Right Side r't Side ..��J
W 9, 5�rnn Oca+e_ io 5 qlj —Fo+cl 6Q S .t. cotic e4e LoI
Haaltlonal worK to oe perrormea unaer mis permit-c-necK-an inat apply: - - -
_Mechanical _ Gas Tank _ Gas Piping —Shutters _ Windows/Doors
Electric _ Plumbing Sprinklers _ Generator _ Roof Pitch
�i
Total Sq. Ft of Construction: 0 � Sq. Ft. of First Floor:
Cost of Construction: $�(� '� Utilities: -Sewer —Septic Building Height:
Name
Address: 351 tJOTt,EM j)gty£
City: rog-r i•D10Qe_ G State: re -
Zip Code: 3 q q 9 Z Fax:
Phone No. -7?� _--) % 16
E-Mail: 5 P 1 62 d o 1 C0 mc< s 4-. Aue-)-
Fill. in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Q krT s PAe.yE,r- (_O ac-v'e-
Company:
Address: l ?,0 2 WE A2AiyC L5� 5 T=
City: 'i-ei1 Sf-r\ 13e4, o--,, State: ZipCode: Fax: Q?yiz 3Z-Sao $
Phone No t''�Z,�G�-�(�oo
E-Mail CQ,n. yers*33g2q36-6. 0 ct v 1. ca r>^
State or County License 2 J—D ) 7
If value of construction is 2500 or more, a' -RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: ` _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I 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: I
Zip: Phone:
OWNER/ CONTRACTOR AFFIPVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installatioi 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 you Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of his 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 appi cations are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming p ols, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Yourlfailure 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 recordine vour Notice of Commencement.
Sigrurk tf O,yer/ Lesb'ee/
STATE OF F�L/ORIQA _
COUNTY OF
The fggyng instrum , was
this day
(Name of person acknowledl
(Signature of No ry Public -
Personally Known C
Type of Identification
Produced=
t o{Pav c�e�c % NotaryCommis1p. 0�� .- Corr
y* P c MY Cor
.o i tractor 5s Agent for Owner
as nowledge, fore me
20Y
l' irF .: 'k •
g)
i ate of Florida)
Produced Identification
G HUFF
ublic to a Florida ,
Ission # FF 2l 730
xpiresMay Assn.'
rough
National Notary
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was ackn,Q41edged before me
-this day of 20_ by
(Name of person ackp6wledging )
(Signature gf Notary Public- State of Florida )
Persona Known OR Produced Identification
Type of dentification
Produc d
i
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUI,�RVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
9
RECEIVED
DATE
COMPLETED
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