HomeMy WebLinkAboutBUILDING PERMIT APPLICATION� � 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �I ' 2� ' l SCANNED / Permit Number:
Building Permit"Application RECEIVED
Planning and Development Services APR - 2 3 1018
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 t de County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Siding
0
PROPOSED IMPROVEMENT LOCATION:
Address: 6dCfi6 11 IQ Y-CL ', I2
Legal Description: r d !(- v (2.1) i ) la i'
(o.6q 46' ( 62 5�aa2-
Property Tax ID #: 2.41 -La - G
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
4WI (a� st d� S o-v\ yea,
U 0 �jc,f ( gvrlat /I,
Right Side: Left Side:
ui-- OU-enf e /-rs�l VI f
Lot No.
Block No.
CONSTRUCTION INFORMATION":
-
_ .. _ ..,.... "
Add itional work to be nertormed under this permit- check
0 HVAC Gas Tank []Gas Piping
all
apply:
_ Shutters
Q Windows/Doors
11 Electric 0 Plumbing
OSprinklers
Generator
F]Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ � S�� °�
Utilities
Sewer
Septic
Building Height:
i
OWNER/LESSEE: ;'
CONTRACTOR:
.Name D '
Name:r�►�fG'c�
Address: , r ' i
Company:
i pry C.
Address•
City: F-i"• ��'�/'�° - State: L
City:
State:
Zip Code:: /qq?o /Fax:
Phone No. -71 � 3?0 6)fo
' IL�J 2
Zip Code: ,3kTq�s/
Fax:
E-Mail:
Phone No.
t0
E-Mail:
fl
Fill in fee simple Title Holder on next page ( if different
from the Owner listed/above)
State or County Lice se:
g7
if value of construction/is $2500 or more, a RECORDED Notice of Commencement is required.
9
L►PPLEMENTAL GONSTtfiUGT101�t
LIEN i111 INFORM�A{►TION� ' <
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
_
Name:
Address:
Address:
City:
State:
City: I
State:
Zip: Phone
Zip: I Phone:
I
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
_Not
Name -
Address:
Address:
City:
City:
Zip: Phone:
I
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, byla,Ws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review yIur deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree I(that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. LL Icie County Amendments.
The following building permit applications are exempt from undergoing a fu I concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms ani I 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 rr�ust be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, co sult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
— ze5���
Signature f owner/ Less/Contractor as Agent for Owner
Signatur� of C ntractor/Lice a Holder
STATE OF FLORID
STATE OF FLOR A
COUNTY OF
COUNTY OF UAe P
The forgoing instru ck ent was anowledged efore me
The forg ing instr ment was acknowledged efore me
this ]-_ day of 20 L (Aby
this Z� day of I 20��y
Name of person making statement
Name of person making statement
Personally Known 2ZI OR Produced Identification
Personal)
Known Y, OR Produced Identification
Type of Identification
Type of 1
entification
Produced —Produced
(Signat � o ota Public -State f!Albe
(Sig of St�*MFlori )
Public Sta�1
Commissio N N� ry pal)Com
hua
' My Commission GG 020679
's Expires 08/1612020 eal)
My Commn 8T9
orF.PIros 08118120
REVIEWS
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ZONING
SUPERVISOR
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17