HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONYy, -
All APPLICABLE INFO MUST BE COMPLE'i EL') FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 333
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)'462-1553. Fax: (772) 462-1578
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Building Permit Application S' In oepa��
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Commercial X' Residential 1(
PERMIT APPLICATION •'
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Address: 09. rod -S+i-WIX A
Legal Description: � w ' 1 IVIC ` �w`� �' IIL 9i � T f- M!p Nalt*
Property Tax ID #: 001— f; off OO-d-�,,_3 Lot No.
Site Plan Name: L� �[te Lt,,l� Q�'jf;, � �''� V Block No.
Project Name:
Setbacks' 'Front 10 Back: '�0 RighiI Side: -;a Left Side:
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AdditionalKworK to be pertormea unaer tnis permit i cnecK aii tnat apply:;_ i
` Mechanical _ Gas Tank _ Gas Piping Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ *0 Utilities: —Sewer _Septic Building Height:
Ol1/NER LESSEE:
GON I "RA iQR:
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Name SG...k ., 4 Aa+�-S �UZZh
Name: �!
Address:.. CI�O� G� c
Company: NLu
Address: 9fdf LiJiL•• /&,G' ie
City: J911,*- & , State: T(
Zip Code:/3 J (0- � Fax: 94t 90Y Y®0
Phone No
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City: gs (T Stater
Zip Code: Fax: - `A
Phone No. y SY8' 09 Sy I
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E-Mail: Sa,aGs.. L Cj j%4 ga.#"i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail oE!/1�{c S.f " C yam: •Gd wi
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SLJPPLE� EN L CU S1` �
C i!d0 t� 7N .A
I� } F � R . A ION• ,
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DESIGNER/ENGINEER:
Name:
Address: '
City:
Zip: Phone
— Not Applicable
State:
MORTGAGE COMPANY: Not Applicable
�VAddress:,..
City:• -a.; State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
— Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
—
Address:
Ad d ress:'
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obta'in 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 ancf covenants that may restrict or prohibit such
structure. Please corisult.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 herebyagree 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•.irryour paying twice for
improvements to your property. A Notice of Commencement must be recorded arid, posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney
commencing work or recording your Notice of Commencement.
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Signature of Owner/ Lessee/Con or as Age
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Signature of%Contractor/Lic se Holder ..
STATE OF FLORIDA
COUNTY OF s� • Lll2.��-
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STATE -OF FLORIDA,,,Cn
COUNTY OF ' I�t-L-C �2. se m
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The forgoing instrument was acknowledged be_
The for going instru acknowledged be
this day of 20�
o T
�ntwas
this Vday of 20�
I� A
P11nCS W, [(CAS D k
8N
I's W l c► ., k
(Name of person acknowledging)
(Name of person acknowledging)
(Signature o Notary Public- Stat of Flori )
(Signature of Wary Public- S e o on a )
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identificatio,�^
Type of Identification
Produced
Produced
Commission -No, • (S(!al)' `
Commission No. (Seal). ;
REVIEWS
FRONT
ZONING,
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
'COUNTER
REVIEW,
REVIEW
REVIEW
REVIEW
REVIEW,
REVIEW
DATE
a
RECEIVED. .
DATE
COMPLETED
Rev.7/2014