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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONFE1, All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (As'\ D Permit Number: RECEIVED S .; JUN 21 2@18 _ Building Permit App ka-ti aunty, Permitting Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential is PERMIT APPLICATION FOR: to,( ,�2, PR++©POSED IN�PR®VEMENT LOCATION: Address%6901 BROOK LINE AVENUE TORT PIE'RC.E . FL 3yq Sl Legal Description: L.o�.ICQ.t�)�di�xi'i�S unit 9 .13I k ldo Lof l(o CM" 15/01 N) COc 4021 • 271-r -7 Property Tax ID #: 13 b • fo 1 l • O 17. 1 • 010 • O Lot No. l (n Site Plan Name: Block No. 101'c Project Name: Lo6.k_2.CsS=Ki Pork Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WOR+K: R-9-10 lac Prrlyc ¢, c�m� �A tri hLmr-i ccy c��. -- a o ut 4L' .h►+vy i nu I 'CG fc�E' 4 ecz-k rnr-± l -c=-s; baj n l i �nIc 5 f cnt_� mcil Qn s - 001 hamQ.r 9�VIINU CONSTRUCTION IeNFORMATI®N: itiona wor to be performea under t is permit — c ec a tat app y: _Mechanical _ Gas Tank , _ Gas Piping —,Shutters _ Windows/Doors' Electric _ Plumbing ,75 _ Sprinklers _ Generator _ Roof Pitch tlu-Ftof Construction: -to ak- Pee* Sq. Ft. of First Floor: Cost of Construction: $ OC Utilities: —Sewer _Septic Building Height: l WNE,R7/LE,S� EE: CONTRACT®R: Name: Name t ¢.S lYl l Z . Adam! Address: b5961 bmolc.1tn(. &jeot Z, City: [-ro,4 Pi ercz- State:- Company: Address: Zip Code: 3�Cl.� 51 Fax: .— City: State: Phone No. 4i06 • $Q (o - 3 8ca Zip Code: Fax: E-Mail: Fill in fee simple Title Holder on next page ( if different Phone No E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. AWL 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 prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the perfnit holder to build the subject structure which is in cbgfliet with any applicable Hgme Owners Association rules, byjaws.,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' tonsideration'of the�granting of -this requestetl 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 StAucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessoty'structures, swimming pools, fences, walls, signs, screen roomsand a ccessory'uses'to anbth'er`nbn-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, cons'ult-vliith Iehder or'a'n-attorney before commencingwork or recordingour Notice of Commencement. S PPLEM�NTAL CONS RUCTIQN LIEN LAW 1NFORMA ION: DESIGNER/ENGINEER: Name: Not Applicable, ,�;;;� � .-MORTGAGE COMPANY: Name: Not Applicable Address: City: _ State: " "•'' �' ,Address: ' City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: � City: Zip: Phone: Zip: Phone: • rra � - fiOne /�Le se . /Contractor as Agent for Owner •i� Signature of Contractor/License Holder , .... .. . .. .��._. �. d_., a ,� a i i ... _ i_..I. . . L • �,. .. , .. .. , STATE,CIF FLORIPA • • � STATE OF':FLORIDA •• � ' COUNTY OF'_, S-�Jc,�-�� •�� , , . � < . ...... • COUNTY`OF �.1 The forgoing instrument was acknowledged, before me 'd,N The forgoing instrument was ` knowledged before me this day of 20 1 by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) i r y< (Signature of Notary lic-State of Florida) (Signature of Notary, •Public:State.of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Cr Plr Produced •. �'•"„���' Mp,RIEGIVENS DEAN ^ ec GG 0?.2023 F, Commission No. I MYCOMt. r� ' ' • ' ' `