HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:'M % )l Al Permit Number: bl,
05 rR
Building Permit Application
Planning and Development Services O E C 0 1 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 H. Y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residerittal ........
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �q, �-
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QPG�i E IMPROVEMENT N160 10 14-
Address: 11-:51 IV&4+1-95' 61\jg
Legal Description: NC, Wes , ZdaA4 7 C - J, A 004 W6 1 J39 04
W_ "5h'Tfr_ 1cor X�l - J?q_'5'1, 3 7?q -
Property Tax ID #: 450 of -,501 000 /0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front /0 Back: Right Side: Left Side:
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INFORMATION
C� R� Tt. N�,IN
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Additional work to be nertormed under t is permit - check all apply:
1]HVAC M Gas Tank DPiping In Gas Pip! — Shutters ❑ Windows/Doors
F-1
Electric 0 Plumbing Sprinklers 11 Generator EO"Roof Roof pitch
Total Sq. Ft of Construction: 770 S Ft of First Floor: 770
Cost of Construction: $ �500. 00 Utilities:cn Sewer 1i Septic Building Height:
Ow L -�E NER
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CONT ACTGR-
Name Ntor-d-h(
Name: .6AtLe_e_
Address 0/.
: ��
Company: ��,Q eye
Address: 11:7,4 i JC J),A , e 174WV
City: 1-7(e he 6.v &,v --L- State:
Zip Code: S3 SG -5-5- Fax:
Phone No.
-
City: Gu"_U State: FL
Zip Code:9300 Fax:
Phone No. A0 2,
E-Mail: )ZQ 19- AWEG
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: C-CC /Y,?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CONSTRUCTION LIEN L. ' .I:NFORIVIATION
,.
DESIGNER/ENGINEER:
X Not Applicable
MORTGAGE COMPANY: 5C Not Applicable
Name:
T
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLD
Not Applicable
BONDING COMPANY: Not Applicable
Name: %i�lC o
h 10 �
�4 �
,�i
Name:
Address: M1 NW 5
Address:
City:
City: FL
Zip: 3 r-)67 Phone:
S- -S 99
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 the jobsite
before the first inspection. If you inteno7o obtain financing, consult with lender or an attorney before
commencing.work om recordingrour tice of Commencement. ,
Signat re of Own / Lessee/Contractor a gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF t�� o ��
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2-0 day of 20�7 by
this _7?0day of 20L� by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of IdenJt'ficatipn
Produced !�/un1G. Ve✓t; ��
Produced
L H- w
"ott�P
�9
.�` N��?....
(Signature of Notary Public-
re of otary Public- State of Florid m'l CO(T M. F.)Oms'
��
MARIA RENTERIA
(at Public, State of Florl
aC
Commission No.
// // _9�t 13, 2021
mmission No.l�y7 /33�1� ( : NO � 1338a2
Commission# FF 961043
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My comm. expires Feb. 16, 20
0
Orc:%-
/1/1111110
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED]
/
DATE
COMPLETED
tev.8/2/17