HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y /,
Date: '1' 3 Permit Number: (y b `1 -y 4 D-p
SCAN E2
Builds'i�gd 'er` ii Application OR 131018
Planning and Development Services Permitt. D
Building and Code Regulation Division St. tucle a minty ent
2300,Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x.
PERMIT APPLICATION FOR: To Select from ropbox, click arrow at the end of line
1`6b41DnC'r,r1€IRItLtU.(l1lG�°/FAIT 1 (lt`/1'Tl'Clll) i , .s.. " z n ° a .. r#
Address: 1005 Buckeye Drive, Fort Pierce, FL 34982 1
Legal Description: White City W 80 ft. of t 800 ft. of S 131.25 it' of S 1/2 of outiot 7 and N 1/4 of outiot 8 less N 25 ft: (0.20 AC) (2083-2,7o"O)
Property Tax ID #: 3404-501-0545-000-9
Site Plan Name:
Project Name:
Setbacks Front Back:
��•
Side: left Side:
Lot No.
Block No.
- . ; i t 5 d all
�.rnRtc�t dt.,fr-rinnl I'NII:rib; ATIMKI. , ._ ..... � :. ..... .,� r.. °. ro '� f,_::, . r . .
Itiona work to be nertormed under this permit— cnecic an t appiy:
aHVAC L_J Gas Tank ❑Gas Piping _ Shutters a Windows/Doors ?�j''
Electric 0 Plumbing Sprinklers 11 Generator L .J Roof �oofpitch
Total Sq. Ft of Construction: % D O I S . Ft. of First Floor:
tost of Construction: $ _ ��7� Utilities: L_J Sewer L Septic Building Height:
��"
WRLSS
31VOJi rN.-,_
CONTRr.ACTrih
Name Nancy Koltzow
Name:
Company:
Address:1005 Buckeye Drive
Address:
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
City: State:
Phone No.772-834-5061
Zip Code: Fax:
E-mail: tt%3�o , ;r [V A1z_ Go
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County License:
from the Owner listed above)
If value of construction is $2500 or more,la RECORDED Notice of LOrnmencement is regwrea.
SURPLEMENTAL CONSl'RU,C710N LIEN LAW IfV'FORNfATION
e ,•; t ,
i U
DESIGNER/ENGINEER: x_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Nancy Koltzow N a m e:
Address:1005 Buckeye Drive, Fort Pierce, FL 34982 Address: 1005 Buckeye Drive
City: Fort Pierce State: City: State:
Zip: Phone 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 perm t 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, scree 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
../.-1..1. ..li .. Ali.+ire of r_nr Innrcmcn+
I
Ser/S tur Ow es ntr ctor as Agen for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was cknowledge¢,before me
20 by
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of
Name of person king statement
Name of person making statement
Known OR Produced Identification
Personally Known V OR Produced Identification
Personally
Type of Identification
Type of Identification
Produced
Produced
Signature of Notary P bli o—Xt e o 4'rr+�,I�
VLFiNN COLLINS
(Signature of Notary Public- State of Florida )
n
Commission No. ✓ §��I�FF196945
FEB 24, 2,019
Commission No. (Seal)
Banded through 1st State Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
i
L
COMPLETED
-1
1
Rev. 8/2/17