HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONCANNED
. BY
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: �. fc a,C 1 �' 3� , Permit Number:
At - --- Building Permit Application
Planning and Development Services Ai `� 015
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Cpmmercial c Residential'
PERMIT APPLICATION FOR: To Select fromll,dropbox, click arrow at the end of line
'PROPOSED-1 M PR'OVE M ENT LOCATION: tt�
Address: 6-P. /,ti C;• ;.n� � l •}: ; cC J - ��l'G (' r\ V'; V' .54• I -Vie ;
Legal Description: ; e 12-1.71 e ` ZL I' L J my i; �r on
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Back: Right
DETAILED"DESCRIPTION,OF WORK:
tij
CONSTRUCTION
.INFORMATION:
-(3 a13-
Left Side:
liaal[IOnal worK LO De er rmea unaer mis permit—.cnecl< an apply:
[=-IHVAC t Gas Tank []Gas Piping _ Shutters
Electric O Plumbing Sprinklers Generator
Total Sq. Ft of Construction: = . - 71 Sri. Ft. of First Floor:
Cost of Construction: $ El
Cost
,� •l:ic
'S 'P 't A
Lot No.
Block No.
❑ Windows/Doors
0 Roof Roof pitch
Building Height:
v�0�°A/NERLE5SE' I
CONTRACTOR:
Name: C #ii•T-1 li
i ..
.Address: ,!%S. � ..5. t'� c: c �� n � r, , ,l c
Company: i IV Vi f? O } Ye 5 .ice
'Ci%y: 5=F sic r_ State: I [-
Address: i 7 �`i C R Lt R
Zip Code:.3 4•Gf 6 -7 Fax:
City: state: FL
Phone No. 1) 0 ,2% -4- .- 2 - 1 � I} {�_
Zip Code: 3 " 1 Fax: .3 K21 - 7 ,5 3
V C 5i- L u L F• CO. o v,
Phone No. .• � 5,?, - Z �
E-Mail: C_ u } : w. (> e� ,i IJ , ha 5qC cer
Fill in fee simple Title Holder on next page (if different:
State or County License: PLC I % �; iv q 50
I
from the Owner listed above)
'
IT vaiue of construction Is , zbuu or more, a RECORDED Notice of Commencement is required.
Yy r. o� $ '
''SU.P;PL'EM:ENTAL-CONSTRUCTION;LI'EN�;LAW_iINFORM/aTION:: `
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: Applicable
Name:
_Not
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'ttat 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
itip commenework or -recording vour Notice of Commenrement. ii 1 - 1
f,
Signature of Owner/ Lessee/Contractor-as Age or Owner
Signature of Conf r/License H der
STATE'OF FLORIDA
IS4- Lwei
STATE OF FLORIDA 1
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged. before me
The forgoing instrument was acknowledged before me
this 06 day of C16 i , 20Lkby
this W day of /'�2aC�� 20 Ids by
/
V t1e0T/M
Name of permV making statement
Name of person making statement
Personally Known ^L OR Produced Identification
Personally Known, X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- �R lorida) lo�ru�y�wu
i ,, KRISTINA
(Signature of Notary Public- Stat ir FJae".
00 ISSION/FF131389
No:FF�3/3y� * EJiS:August20,2018
Notary Publlo • StsCommission
Commission No. r DE fIE� x'�i) Commission N F
WedThruBu*NdaryStokes�%Rft
My Comm. Expires
� Bondedthrouph.
REVIEWS
FRONT,
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 /