HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO T BE COMPLETED F R APPLICATION TO BE ACCEPTED
Date: Z� 1, ��6 Permit Number:
Building Permit Application
Planning and Development Services DEC 2 $ 1011
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 , BY -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResideAffil"-------
PERMIT
APPLICATION FOR: To Select from dropbox, click arrow at the end of line 5
PROPOSED IMPROVEMENT LOC N: t'
Address:
al Description: rh e e I 4
I n� � 2 C'D /�+ � ti ► //l . 3/„ S � �tr►ra �7 �� ! �t l � 1 u r�,.P
Property Tax ID #
Site Plan Name: -AY pAdkdue
Project Name: (�
I
Setbacks Front Back: Right Side: . Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
neat- Sf`rglc: S�.y 85 SOWncc .r�l • 3
a2 3 �. �'V I /� 2 7 -/ of ��&
�l �
CONSTRUCTION INFORMATION:
Additio wor to e e rmed under this permit —check all apply:
In
r
LJ-
HV G Tank ❑Gas Piping _ Shutters Windows/Doors
Electric r Plumbin Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: 53 S . Ft. of First Floor:
Cost of Construction: $n7 Utilities* Septic Building Height:
OWNS LESSEE:
CONT TOR:
Name 0 A pru 1,
Name•
f
Address: !
Company: C
City:" `i- State;f
Addres .
Zip odAnFax: ^
City: `f' 1 State:
Phone Q 0
Zip Code: ax:
E-Mail: L
Phone No. -• � � "' 3
Fill in feHolder on next page (if different
E-Mail:
from the Owner listed above)
State or County Li se:
r
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DES N
/ENG NEE Not Applicable
MORTG COMPANY:
Not Applic ble
Name:
Name:
Address:
Addr
City:
Zip:
State:
hone -7, J
City:
Zip: Phone:
St te:
-
FEE SIMPLEJ E HOLDER: _ Not Applicable
BONDING COM ANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 pE
which is in conflict with any applicable Home Owners Associal
structure. Please consult with your Home �FloridaBruoilcding
In consideration of the granting of this req
in accordance with the approved pla a G
will authorize the permit holder to build the subject structure
ules, bylaws or and covenants that may restrict or prohibit such
review your deed for any restrictions which may apply.
by agree that I will, in all respects, perform the work
and St. Lucie County Amendments.
The following building permit ications are exempt from der g a full concurrency review: room additions,
accessory structures, swi ng pools, fences, walls, signs, sc ,rooms and accessory uses to another non-residential use
W RONNG TO O ER: Your failure to Record a Notice of Commencement may result in your paying twice for
im r to your property. A Notice of Commencement n st be recorded and posted on the jobsite
b e fir spe�ion. If you intend to obtain financi , consu th len�er or an attorney before
ommencinE r o recordinE vour Notice of Commen ement.
Signs ure of Owner Less ont actorAs Agent for owner
Signature of Con ractor/License Holder
STATE OF FLORIDA I
STATE OF FLOPEJA
COUNTY OF 6+- % Qb-
COUNTYOF • LOc�2
The for,going instrument was acknowledged before me
D'e
The for oing instrument was acknowledged before me
�� day 20 by
this4L" day of e . 20jI by
this of ��r , t�
''-T
Sy s � ,n Qa r b �. f
5 O sb .n •�w r �, ,e; {-.
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 Identification
Produced L 0 "L.
Produced V— L DL
(Signature of <w �, lic- Sty rr oz2�23 ,
'•
4 '`•;
(Signature of Notary P lic-State of Florida
--
M9ARIEGNENS
> ry- G 022023
Commission No. . sSSI0N0 2p20
e... 96,
_ MY COMMISSION
o'�
- RES: December 96, 2020
Commission N . P,SeaG)teF
:9PR' on hru Wo1ary
enrvn
pIR Ueee Und sere
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2"L ae NSNotaH�uolir
son ded��
REVIEWS
FROM
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
OJI"4
DATE
Q
COMPLETED
Rev. 8/2/17