HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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-- •. Buili'i i ISOr'mit Application PQr,�1AN 2010
Planning and Development Services ��; ti�gj�y0,
Building and Code Regulation Division�q epr
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 lommercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: / 6 1 0 1 S. 6 CLAN D KI, $ Sq ;S---n_ivSFes. 3 `f t 5-1
Legal Description: _ V E-" T-u 1S o ✓ �,, A--r / I D I A" X 1 i/4-yt >lvC ,
Property Tax ID#: L1gI I - 5-1 o -d0(�n0I_0 00 'S
Site Plan Name:
Project Name: t- S T C-PS Q N
Setbacks Front 2 b 7 Back: N!i Right Si
4-xIS ►rf C- C,0/NGPL-(_-r4_-
LeftSide: Z6,0
Lot No. 19
Block No.
DETAILED DESCRIPTION OF WORK: I.
C. G�G-
eGr''er•'l�C,
CONSTRUCTION INFORMATION: j
rtiona wor to e performed under this permit — c ec a apply:
I�HVAC E]GasTank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: �2 S . Ft. of First Floor:
Cost of Construction: $ oa Utilities: Sewer Septic Building Height:
I
OWNER/LESSEE:
CONTRACTOR:
Name 1 ?Alt ozD 0 3oiJz-S
NIIme: RICHfhtp F_ Iv;vlzlLAy
Address: /2-3 .14NizAiS X<3ml>
Company:__5'Noiz-zr,_,Irvz /t,V, $m.14. RZr'r+12 /NC.
City: State:/VT
I
Address: 12-9o N rgvsiNoass rlc FL.
Zip Code: 48 5TO Fax:
City: '57r_-" S EN State: r— I
Phone No. (a 6 9- G, S 8' - '78 3
ZiplCode: 3 `l 9 S 7 Fax: 7111 z,3 3 Y-`03 S
E-Mail: YeLLaw C�)I/ A 6 9 @ yAHoa, ca van
Pholne No, '7'7 -2- - 33Y-Y33 `/
Fill in fee simple Title Holder on next page (if different
E-Mail: K V M `l 8 157 cdD (�- 6 L C a M
from the Owner listed above)
State or County License: C MC. 6 7 Z��
IT vague or construalon Is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON STRUCTION'LIEN�LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: IC, V ALC II q
Name:
Address: /3,9 S, /v/�-schwr)9 A-vk&
Address:
City: /"s Z. State: z
Zip: Phone �? z-� 7 �— z-Ys
I
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: one: l
I
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 priorlto the issuance of a permit.
St. Lucie County makes no representation that is granti
which is in conflict with any applicable Home Owners P
structure. Please consult with your Home Owners Asso
rmit will authorize the permit holder to build the subject structure
ion rules, bylaws or and covenants that may restrict or prohibit such
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 Buildin&odes and St. Lucie County Amendments.
The following building permit applications are exempt from
accessory structures, swimming pools, fences, walls, signs,
WARNING TO OWNER: Your failure to Record a No
improvements to your property. A Notice of Comi
before the first inspection. If you intend to obtain
commencing work or recordin our Notice of Co
going a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
:e of Commencement may result in your paying twice for
encement must be recorded and posted on the jobsite
financing, consult with lender or an attorney before
mencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 42�A. -
COUNTY OF ►.c. o
The forgoing instrut was acknowledged before me
this � en
day of 20JL by
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement
Personally Known OR Produced Identification
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- Stat of Florida)
(Sig ture of Notary Public- Stfte of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVI
I PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
l
DATE
I
COMPLETED
Rev. 8/2/17 1 t k /