HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I ,� O
Date: to 6LAiVifto Permit Number: u
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-- Building Permit Application �s w490�
Planning and Development Services 4►
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR:' To Select from dropbox, click arrow at the end of line
PROPOSED IIVIPR01lEMENi' LOCATION ���` � � � k
Address: �s3sl' 111194MAJ D12.
Legal Description: V C?>�S7' 7�IQ�"/J�-�• L01— —7%
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Lot No.��
Block No.
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Additionalwork to
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be erformed under this permit— check all
apply:
1]HVAC
Gas Tank' Gas Piping
_
Shutters
Q Windows/Doors
11
Electric
Plumbing
Sprinklers
Generator
0
Roof
Roof pitch
Total Sq. Ft of Construction: S�Ftj. of First Floor:
Cost of Construction: $ 90/0 Utilities. L_JSewer Septic
Building Height:
OWNER/EESSEE ' S xf ' R �'„ '
_, 985
CONTRACTOR
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Name T-fl' 615 sr TidUIEN
Address: /,c7 ��:cy ftoiu_DiZ
Name: EpIC �n p/i/�"
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Company:�c..�J01R)/L7_CbAML
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City: (7 State: _r%IO-
Zip Code: Fax:
PhoneNo.9fV — L-1),,(i3s'
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City: ART- Lucie
Zip Code:; Ligi?3e Fax:
Phone No. r7t7o? - 9Qlo
State:(_
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 0 #11&?. G ,!W Qm
C/ C-0ty,
State or County License: 011001W693
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: `
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:_
Address:
City:_
Zip: _
Phone:
Not Applicable
State:
Not Applicable
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, 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
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Signure of 0 r/ Lessee/Contractor as Agent for Owner
STATE OF FL
COUNTY OFORIDA Jr �CiE
at
The forgoing instrument was ac <nowledged before me
this !ay of 204 by
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced /1
(Signature of Notary hyrblic- State of Florida )
Commission No.IT 133 r (Seal)
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lit-ciIK-_11 .
'*-/)"", /V-z' 17 A � � �
Sign ure of Co 7
tor License Holder
STATE OF FLORIDA
COUNTY OF r
The fo instrument w knowledge before me
this of 20A by
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of Notary P.�L#ic- State of Florida )
Commission No. v r (Seal)
Kimla i Simone a�Y Notary Public Staleof Florida
REVIEWS They r3'QN4[gG98133 SU RVISOR PL". NSA E AT11�l&n SEA TURT E MANGROVE
I TE14Pir' �% IEW REVIEI��V 1`RffgfBWlnjgsion Fss� s�rlE REVIEW
DATE ;
RECEIVED
DATE
COMPLETED
Rev. 8/2/17