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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE /INFO MMUS. COMPLETED FOR APPLICATION TO BE ACCEOTED Date: � 1 l�J '- �p ��' SCANNED Permit Number: a • OSo� 1BYR CFtV 1 S.t Lucie COMY Building Permit Application Per FB20?ore Planning and Development Services pp mitdn St Cp e0c tent Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Unty 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, LOCATfON . Address: 3�3 ( I � r) I I Y, Legal Description: -_n6,n.,Tk1 L , r )J] N G Property Tax ID #: -1Q a.- ©Q Cl% �C�O Lot No. Site Plan Name: RE7Na � � , L.. L-,�-C.Ain1 Project Name: Block No. Setbacks Front Back: Right Side: Left Side: DETAILED DE SCRIPTION:OF:WORK: `ZEPLAU M TIP.N ?_oa V wlZw �OL� P-c�� ©N �s-CiNG ' �"rtwcTt7 "CONSTRUCTION INFORMATION. itiona workto e e orme un ert is,perm �-c ecY`a app y:. EjHVAC — Gas Tank ❑Gas Piping _ Shutters ndows/Doors Electric 0 plumbing Sprinklers Generator �f — Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ < '2��- Utilities: _ Sewer Septic Building Height: Sr OWN ER/LESSf E `. 'ONTR O.A N, NAuLJ r `N. Name: DAV,.ifl vJPbv.2,j Address:_ 1 - �P-AR�Wr301> C.(y Company: WNc�. Aw�ailvuln Lc�tNnoks, City: _ i'�oQ-r �� L� - State: L_ _ r Address: 31q NW CNCI✓lZ,��,s� Zip Code: _ 7.- Fax: Phone No. �D O Z • Q4CI GCJ City: State: t L Zip Code: 3 S t� Fax: 77Z• `�7%- Za3rj E-Mail:_ Phone No. 7'7 Z , 7-12. 1 A p® Fill in fee simple Title Holder on next page ( if different E-Mail: _AkA r- r t4 p y. 4% %TP `rom the Owner listed above) -t uv► tm v-#r% , C,.p-,1,.1 State or County License: 2 f value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 1S02.0"(P `5 SUPP�LEMENTAL�CO,ISTRUTION'1;IN,LAW INFORMATIO)N 1 f4r'f DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable Name: I 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 your Notice of Commencement. Z�IZW 1212,4,14 === //�/d4J/ Signature of Owner/ Lessee/Contract as Ag'en for Owner — Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF__<7— X_ COUNTY OF ST (f/,rc The forg_o}'pg instrument was acknowledged before me /f The forgo' g instrument was acknowledged before me thism i�•�� 20ZC— by this y of !!CX41 , 20Z-by y of . Name of person making statement Name of person making statement Personally Known _Le!!!:�: OR Produced Identification Personally Known ,eo< OR Produced Identification Type of Identification Type of Identification Produced Produced (Signatu e-&Notary Pu ic- State of Florida) (Signature o Public- State o Florida ) �Y.^ta ., ANN M. GAUMO Commission P qq�' �: @�a� ,A4ISSION # FE 1'�391J� Commission NO.' '�Y P ,.�0 ya., ANNM.GAUMT _tr #_ MMISSION # FF 173507 �• :; EXPIRES: December? 2018 = :a EXPIRES: December7, 2018 Bonded Thru Notary Public Underwriters !!!! '%'; " Bonded Th pg,� c. ru Notary Public Underwriters PLANS VEGETATION SEA TURTLE MANGROVE REVIEWS FRONT ZONING SUPERVISOR COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17