HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�I
_�T
ALL APPLICABLE INFO MUST BE'�-,C AIIPLETED FOR APPLICATION TO BE ACC& riD
Date: Permit Number:
�Rr ANNI RECEIVED
ucle _0
Building erMit �►pplication
Planning and Development Services Permitting
Lucie County tyent
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
.PROPOSED IMPROVEMENT LOCATION
Address: i l `3 &JeeN+p C-b LDo// ;
Legal Description: ( (.3 QJe2N (,e45 Coo Q 0f2UIS C6J,0- 51 tIAStdA
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
I r) 3-l-&. t
V f h y Ort, c,
-k) J W oo a c
o
W w C
R-Pd' oar n� is-sit-Y
2 qo L
CONSTRUCTION —INFORMATION —., -
Additional work
F1HVAC
to e e orme under this permit —check a
1. ❑Gas Piping
apply:
Shutters
Q Windows/Doors
Gas Tank
_
Electric
❑
Plumbing
0
Sprinklers
11
Generator
0
Roof
Roof pitch
Total Sq. Ft of Construction: �� I� S . Ftofof First Floor:
Cost of Construction: $ 6710 -D,`� Utilities: nSewer Septic Building Height:
_._,
....._.-
Name C! (Lck W �vlann�
Name: 0 yal:n4 PA-Citlle,
Address: t 13 Q
Company: o uk-
City: tav alerc,2 �(.Q&fy))ts State:_
Address: OA4e-g L-0')
Zip Code: � _ Fax:
City: ICAO 6eA_eJf , �I_ZR40A- State:
Phone No. 5 7 ill 53 Z g
Zip Code: y Fax: � � f
E-Mail: V N DT 5 P, 16 I o U& .Lolly►
Phone No. 17 Z 32-1 - 99 +
Fill in fee simple Title Holder on next page (if different
E-Mail: (n t? It I I'D C.0 rnS�Y tJC @ �l
from the Owner listed above)
State or County License:4 /_ ,9 !�j a
If value of construction is $2500 or more, a RECORDED Notice of commencement is regwrea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: 5 Lo c v 10,L
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: a o
a
Address:
City: AJWV
State: �
City: State:
Y
Zip: -6 Phone 222
- 6&9- T�5-b S
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ 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.
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
commencing work or recording vour Notice of Commencement.
as Agent for Owner I Signature
Holder
STATE OF FLORjDA �—�p STATE OF FL(f DA
COUNTY OF clir" f`.'Irti/ COUNTY OF_ lr�.(.Sh 2 v-�
The forgoing instrytaent was acknowledgeefore me I The forgoing ins�rument was acknowledged before me
this Irday of Ja.,.,av'u 20IJ by this 1,5- day of 20ff by
Name of pegs aking statement
Personally Known �OR Produced Identification
Type of Identification
Produced
MY COMMISSION # GG 06jQ886a
—�pIA�Jannary 30, 2pp��
Bonded Thru Notary Public Underwriters
Name of per making statement
Personally Known rX OR Produced Identification
Type of Identification
Produced
(Signatu
MY COMMISSION # GG 0§7886
—ERPIRE6'J-nuary 30, gal)
Bonded Thru Notary Public Underwrites
REVIEWS I COUO TER I R�VIEW I NING S REVIEWOR I REVIVI PLAI VEGETATIEV EWON I SEREV EWLE I M EV EWVE
DATE
RECEIVED
I COMPLETED
Rev. 8/2/17
1ta ..