HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPI!ETED FOR APPLICATION TO BE ACCEPTED
Date: % I Permit Number- %_d y' �33�
BY loot- oqa
St LUCLe Coil*
Building Permit Application�`�°
Planning and Development Services ��*� QavnA
Building and Code Regulation Division CP
`���o��e
2300 Virginia Avenue, Fort Pierce FL 34982 v
Phone: (772) 462-1553 Fax: (772) 462-1571 Commercial Residential
PERMIT APPLICATION FOR: N
.PRQP:OSED f:NI;PROVEME:NT
Address: ayee, pP.SS C�: �II
Legal Description: Oc to c; Cye. - Qnn -1-2 Lo'- C 6
Property Tax ID #;
Site Plan Name: _
Project Name: _
V1q -70.'!-Do,1't - nen -
Lot No.�
Block No.
Setbacks Front Back:_ Right Side: Left Side:_
1
DETAILED DESCRIPTION OF, WORK
n 0-All et new o n P_egr- d L ek-Adknj c✓1-I-L e- R 6 oreadr�^�sS
.CQNSTRUCTION.J N FORMATION
:
Additional work to e performed under this permit - check .
a
apply:
❑HVAC
Gas Tank
❑Gas Piping
_
Shutters
❑Windows/Doors
®Electric ❑ Plumbing
[]Sprinklers,
❑ Generator
❑ Roof Roof pitch
Total Sq. Ft of Construction: �Od
S . Ft. of First Floor:
Cost of Construction: $ y8, Uoo
Utilities: Sewer []Septic
I
Building Height:
:OWNER/LESSEE:.
CONTRACTOR: d bu A
Name 1_0ca,
Name: T _
ICompan y:�,rt�i�►� i' c�OaL 5�� �n�.
Address: T31 BUJ 0419ag2a 4A
City: "J, Stater
lte�
Add,l
ress: 0. hex i80zy
City: Soh aJb"e, State:
Zip Code: -qlq (�g Fax:
Phone No.
Zp Code: 3�_*15�9 Fax:
E-Mail:
Fill in fee simple Title Holder on next page (if different
Phone No. 7Z- 266 -- a2a'/0
E -Mail:
from the Owner listed above)
State or County License: 12 PSG 41y1
3-,;L
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
'SUPPLEMENTAG'CONSTRUCT_I�ON LIEN LAW
INFORMATION:
DESIGNER/ENGINEER:
Name: &%aeJ A:` S144-
_INot Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address: 4/a'7
City: M:r+S
Zip: 12-752�( - Phone
I Stater
I
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
1C Not Applicable
I
I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
I
I
I
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Apblication 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 Ow6ers 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 our Notice of Commencement.
�1Lit,
W41K"��
Sign wner/ Lessee/Contractor as Agent for Owner
Sign a of C ntractor/License Holder
STATE OF FLORIDA
I
STATE OF FLORIDA
OF'Zr�nAj/,tJY1 a�
COUNTY OF 1�1/:Lr C
COUNTY l V
The for oing instr ment as acknowledged
before me
The forgoing instru ent w acknowledge efore me
this day of
20� by
this � day of 20 ��by
1/1
I
Name of p rson king statement I
�OR
�� Na?he of person king statement
=
Personally Known
Produced Identification
Personally Known R Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sin ure of Not St
e blf'I }d��2UNZWElO
(S na re of " .pull IG
�P,urLitic-
=• Y
Commission No. +
MMISSION # GG064087
IRES J&* 18,2021
=' �•c MY COMMIS �#8
Commissio Jarj
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
I REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
�_W
DATE
COMPLETED
Io1l$
tev. 8/2/17
1