HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date" aC I� Permit Number: 1 0�Q 0 Q__ 0(paAI '
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Bulling Permit Application f-e�°ti6
Planning and Development Services :,.:moo o iPacounpt
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residents
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED] MPROVEM ENT LOCATION:.
AddressRsoko C:��ES i�.i •, . S� �CAn�. 9 b -I
Legal Description:
PropertyTax ID #: ":)!,( I D-2SU) l.. 00L
Site Plan Name:
Project Name: G ) ) y-"t" ,'�-
Setbacks Front_ Back: _ Right Side:
DETAILED DESCRIPTION OF WORK
Lot No,
Block No-
CONSTRUCTION INFORMATION
Additional work to e e orme under this permit- c ec a y: app
F1HVAC E] Gas Tank Gas Piping _ Shutters 'Rwindows/Doors
�4_ e ct r i c 1:1 Plumbing Sprinklers 1-1 Generator Roof Roof pitch
Total Sq. Ft of Construction:@ S . Ft. of First Floor:
CFQ � i / I�
Cost of Construction: $ IS (��7 Utilities: _Sewer Septic Building Height: '"h
OWNER/LESSEE; :
CONTR TOR-
N a rn e_76yn d in CM_S_C�-A t n 1 y
•�i 4:1
City: 2— State: -
Zip Code: '9 Fax:
P(tbne No. :33 4 —_ �on -
Name:
Company: e ' )�ry
Address: _ W,S Iai
City: State
Zip Code. toi Fax:
E-Mail:
Phone �(Q
Fill in fee simple Title Holder on next page ( if different
E-Mail �_'C'Jz0TY\o-rY-'5- V' U:O
State or County License: C_k1NC0q\1�N�
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONS
DESIGNER/ENGINEER:
1ON LIEN".LAW 'INF.O
Not Applica
Name: ttr Ck o� T
Address:Q I %kr, P-.--%-
City: (PState
Zip: -qn Phone (� — 71:1 S
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: Same
Address:
City:
Zip: Phone:
R
MATION
MORTGAGE CO PANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING ANY: 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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co-mmencine work or recordine vour Notice of Commencement.
own erX Lessee)�ontractor as Agent for Owner 5i rWtafe of
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Zk COUNTY OF 5 ,1.,1CZQ ,
The forgoing instrument was acknowledged before me
this Q(o day of V*—b 201? by
Name of pi6rson making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signaturb of Notary Public- State of"Florida )
Commission No. a �i5eal)'
LASHAHNA INBRAM
a°�.RY PL;K%„'; Notary Public State of Florida
`•`••a ,A * s u,. ro mm Fxnires Dec 20. 0016
The forgoing instrument was acknowledged before me
thA,L; day of -Feb 20V by
Name of persdh making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signs ure of Notary Public- State of Noricla )
Commission No. (Seal)
LASHAHNAINGRAM
Notary Public -State of Florida
:? W +� coniroc nar 20. 201
REVIEWS
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n # FF 177249
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lesion # FF 177249
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`""REVff REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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