HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �5 1 Permit Number: N1 VQ` 0 AA 0 5
19 (IT, M 977M D�
Building Permit Application I DEC 15 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_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �) (3 L
PROPOSED IMPROVEMENT LOCATION:
Address: iJ65Y -� 3:-W CJ l A N 41gtfZ, D L Ron
Legal Description: `i'�`tU 7. �'1'
1-6-r 2 L, �F FrL '(Z wt i� 3g -D& 3 ,�c
Property Tax ID #:
Site Plan Name:
Project Name: WCNZL ��� piAt V
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Re CowsTtuerc- %�< aA t S°nnrr - TV km clfv�0, cOCk- s-r l -s -M
CONSTRUCTION INFORMATION:
Additional work to be vertormed under this permit- check a
11HVAC U Gas Tank ❑Gas Piping
❑Electric 0 Plumbing 0Sprinklers
Total Sq. Ft of Construction:
Cost of Construction. $ H L h 000
Shutters Q Windows/Doors
Generator Roof IRoof pitch
Sq. Ft. of First Floor: _
Utilities: Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name tbACLF,
Name: .5c.otf
Address: H 655 S TNd(Avv WV', - A_
Company:
h3
City loyT" `PtW -Ce- State:
Address: S)-s SF,
Zip Code: .3�fglY � Fax:
City: L CAM
rlc State:
Phone No. 7)- 495-Z299
Zip Code: 3'J'1SZ Fax:
E-Mail: V
Phone No. `l-)3 3 �-
D
Fill in fee simifle Title Holder on next page ( if different
E-Mail: r
L
from the Owner listed above)
State or County License:`x
If value of construction is $2500 or more, a RECOROEo Notice oT commencement is requireu.
J
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
_ Not Applicable
Name: L
Address: l9a N Ih1I. J
City: PSL_ State: FI.
Zip: 2 Flo 95-2- Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
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 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 poste on the jobsite
before the first inspection. If you intend tog financing, consult with lender or an y before
commencing work or recording vowllolWof Commencement. i�
Signature of Owl L9§6eJCor�Xor as Agent for Owner I Signature of
STATE OF FLQMDA l/
COUNTY OF 5 , L c \k
The forgoing instrument was acknowled ed before me
this\ 5 day of �Qc .20n by
2-
.)za
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced V- L. (� L
(Signature of Notary PVblic- State of Flori
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Commission No. o�t�,Ss bet �6 2p261ecs
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REVIEWS F '" CONING SUPERVISOR
CO TER REVIEW REVIEW
DATE n \
DATE
COMPLETED I
Rev. 8/2/17
STATE OF 5W14DA
COUNTY F S'i
older
The forgoing instrurnent was acknowledged before me
this \1�) day of V ec_ . 2011— by
'Z'co+ar 5�Z.%�c0,,ns)c l
Name of person making statement
Personally Known OR Produced identification
Type of Identification
Produced C' L Ib LL
(Signature of Nota u r� GIV -NS icA
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Commission No. �p a 6,2020 :r
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