HomeMy WebLinkAboutBUILDING PERMIT APPLICATION/151 APPMCABLE INFO MUST BE COMP FOR APPLICATION TO BE ACCEPTED / n
Date: * Permit Number:
-- Building Permit Application
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:
$s , 3r' ffi� .. 7 � yy _ 4—z» v ',kR;ti'+r a�l�. SF .'r R r �,
,.'=k�� f Y1Y?�1,1�"te.'t�yF IaSS na Fl°„� Jit' «, aa:�..`�y,7• '! 'k Baia 6
�„ ,, $ � ��- we �s
-c'+ ... 12,uL � '•`�i'��...a�3a�-
Address: 5
Legal Descrip7non:
Property Tax ID #:
Site Plan Name:
- o0l C� 0DO- Lot Not_
Block No.�
Project Name:
`Setbacks Front ' d ¢ Back: - 30 Right Side: 1�'(W Left Side: ( , DD
:71eectric
Pl
hanical _ G�as�Tank _ Ga
umbing —Sr
Total Sq. Ft of Construction:
Cost of Construction: $ �s�i� # �� Z
Namely
Address
City: I=
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
State
Zip Code: �c qq q Fax:
Phone No.) - 653 6
E-Mail: PS 1 &0P paq(aI II
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: K
Company:
)Windows/Doors
:;.e-Roof
Building Height:
Address: �1�1 �SvO MtAK,4- ,,l (fi KQ ,
City: t T; 5 Q i,i {.. Stater
Zip Code: 3 Fax:
Phone No.`)—)C•-
E-Mail: `
State or County License:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S.. 6 'd, T ">. ...'�/.a'L�/M,�.a.ee
1'
tk>c.,,-� ,. m"`T'�v,.
K^ _: ^•. S"> ', s—.. t, h'... _= a'L-.c�` r,AN Of 0
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not ipplicable
Name:,r �� %11-�.�
_
Name: Co f ,
Address: 10184 <5��a; 1+�lS L ,
Address: ,� d s
City: '90'r-y '-s2k, Stq ej: C
City: State' z
Zip: �(� )g!d Phone:�'�.... n
Zip: Phone:(
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: 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.
.1 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 thepermitholder to build the subject structure
is in with any applicable Home Owners Association rules, bylaws or an covenants that may restrict or such
which conflict prohibit
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 intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
e4_<
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF Ci
COUNTY OF S+ • J Qt_
The forAo�ing instrument was acknowledg d before me
this1" day �1i►1'E�i1✓ 20 �� by
The for$o_ing instrument w s acknowledged before me
this�Hay of 0 20L by
of ,1 .
,
Mmy�� Ito
mrow, N'D
(Name of pers n acknowledging)
(Name of person acknowledging }
(Sign ture of Notary Public- Stat of Florida)
(Sign t re of Notary Puubblic- ate of Florida )
Personally Known OR Produced Identification
Personally Known
Type of Identification Produc
Type of identification Produ
yf �� ssion # FF 949733
Commission No.
7 `r Exp�J�fCps J uary 12, 2020
Commission No. ;3'°•� Bcnd�di�riF{Faminausnceeo03ea7o,9
;� Exp`lie� January12, 2020
` ... n„. Bonds dTlouhoyFaMInsysneeMBS-7019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 1