HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL AF
Date:
INFO MUST BE wiAPLETED FOR APPLICATION TO BE ACCE _ D
Q6 Permit Number: Mn.
Im D
By
St. Lucie cofj*
Building Permit Application
Plannin' and Development Services
euildin� and Code Regulation Division
2300 V rginia 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
PROP ? SED IM'PROVEMENTLOCATION.
AddreJ: —73-3 M A-95
Legal Description: _,i'1! 6! /f 44041)14A AT LAE A54zt lV -
Property Tax ID #: 33a I "gb `t (,Oa 7-0 co - 8 Lot No.
Site PI In Name: ' i 1 Block No.
Projec Name: 73� /c� �/�aa � /"� � � MA-1�1 A- t ff AIA V (E 6-,*
Setba,lks Front Back: Right Side: Left Side:
DET � ILEDDES"CRIPTION OF WORK.
A Vt A"r "&�— or-n ) (�?
CO.'STRUCTION INFORMATION ,.
. '5HVAC
ona : , ... .,._.,_. .,
workAddto e e orme under this permit- check a apply:
Gas Tank Gas Piping _Shutters ❑ Windows/Doors
13 Electric F� Plumbing Sprinklers 0- Generator E]Roof Roof pitch
T
Sq. Ft of Construction:
)f Construction: $ ygmovJ
S Ft. of First Floor: _
Utilities:n Sewer Septic
Building Height:
O NER/LESSEE
..
CONTRACTOR: _
4j�'e MA24f �•
Name: �g.. Tf d_deTc-(7Q
Ad ress:7 �✓��
Company:
Cit�: State: r(-
Address- e2 1.90 AIL,) 1e 2 old
Zi ,l Code: 3 8(- Fax:
City: f_ State: 1�L
Ph ilne No 7 �80 - O
Zip Code:.346�%� Fax 77A)M-= 668
E- ail:
Phone No.(77A) 8-7ff=733 Z
Fil I in fee simple Title Holder on next page if different
E-Mail: SpP-I/AIG C-d
fr Im the Owner listed above)
State or County License:
If y,'alue of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
SUPPI MENTAG.CONSTR'UCTfON LIEN LAW -INFORMATION
DESIG ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 11
_
Name:
Addres"' :
Address:
City: I State:
City: State:
Zip: I Phone
I
Zip: Phone:
FEE SI ' PLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
_
Name�'l
Name:
Addre "s:
Address:
City:
City: I
Zip: Phone:
Zip: I Phone:
II
OWE
/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
tify hat no I cerwork 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
structur . Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consi a eration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in actor, ante with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The folI ilwing 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
WAR '1NG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impro I ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor the first inr�sspection. If you intend to obtain financing, consult with lender or an attorney before
com 'encine wcrfk or recordinzvour Notice of Commencement.
ST
The
re of O, ►per/ Less ee/Cr/n�ractor as Agent for Owner I Signature 4'f Contractor/License Holder
OF FLORID ��n� ��QQ I STATE OF FLORID
'Y OF2 COUNTY OF
ing instrument was acknowledged before me
day of 9MAc 20/7 by
Name of person making statement
orally Known OR Produced Identification
of Identification
aced b, L'
of
MY COMMISSION # rr• a
EXPIRES: February 5,
Bonded Thru Notary Public Un
lic- State of Florida )
(Seal
EVIEWS I FRONT I ZONING
COUNTER REVIEW
CEIVED
ATE
IMPLETED
8/2/17
The foring instrument was acknowledged before me
thiso7 day of toff by
Name of pe son making statement
Personally Known OR Produced Identification
Type of Identification
Produced
90
(Signat of Notary Public- State of Florida )
111 Commission No.
g RA L LA
MI� BSSION # FF 144434
EXPIRES: August 12, 2018
Bonded Thru Notary Public Underwrite,.
SUPERVISREVIEWOR I REVIEW PLANS I vEGETATIEVI WON I SEA REVIEW TURTLE
VEWLE I M EVIEWVE