HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL A PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -1
Da '��o W NK-1 i Permit Number: � Q 0 ( 1 - d1 l�
a -i
IIii nn��p,iL
LLMg1 'a 01NWi`�1�
ERECEIVED
Building Permit Application6Plar��►ing and Development Services
Build►ng and Code Regulation Division nty, Permitting
239P Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
gr
Ad Bess: � � • �L �� i n ►
Leg.;l I Description:
Property Tax ID #: oI OJ C It 7" t
Site Plan Name:
Pr11ject Name:
Sgtbacks Front- �_Back: Right Side
Left Side:
Lot No._
Block No.
Cv N �- (1 �� 4. Sc.., —�U (L
K 1 S L cOd C ('SCV , fD(t'
Iditional work to be performed under this.permit -check all t= apply:
11HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator FIRoof Roof pitch
tal Sq. Ft of Construction:
ist of Construction: $ 110 O
S Ft. of First Floor: _
Utilities:D Sewer E]Septic
Building Height:
l{`�
t,.'*td, ,.4
Name: hgaS SJ..,.CO s vJ�
Address: 9B5 S► � e,�n'kl►1S___ _
Company:.` ( w e
City: F. a State:rJ-
Address: 46, q S . Wtsl_kSA 69
Zip Code: INq Y Fax:
City: Iff 1 - State: l�-
Phone No.
Zip Code: C Z Fax:11DL 4 -1�
11
E-Mail:
Phone No. 90p �-
Fill in fee simple Title Holder on next page ( if different
E-Mail: 6O 6 h r-, e W :1 o- be kk Soy , n'e
from the Owner listed above)
State or County License: Q C11 C ��
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.Y ti, s';S'
.,;r{If..,Ylf
�y�
x�aE
�� ��.'�Yv�15a �r.��•..:t�t�.S;i..7(+{'.�f3Fj"�.;y,�fei�t,�J1..YJ7�t3,4��.;;ir:��7.'t.lititfa°;rr:Ff`�,�1,,.:Fi,�.�)4r,$,�est..:.t�;..Y
�3z4 Z,��"fia,a '`ii_�,vXfi-Y�..p
DESI NER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Nam' :
Name:
Addr � ss:
Address:
City:' State:
City: State:
Zip:.I Phone
Zip: Phone:
FEE IMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Na
Name:
Add ess:
Address:
City:
City I
Zip: Phone:
Zip: Phone:
OW R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cert• that no work or installation has commenced prior to the issuance of a permit.
St. Lu ie 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
struct re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In co ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in ac rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The f Ilowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acce 'i ory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA NING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
imp ovements to your property. A Notice of Commencement must be recorded and posted on the jobsite
bef , re the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnr i"monrino wnrk nr rarnrrlino vrnir Notirp of Commencement_
Si ature of Owner ssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
S ATE OF FLORl A
C LINTY OF Sir . X- \
STATE OF FLORIDA ,
COUNTY OF S�. L J
T II o omg instrument was acknowledge before me
'IS- �� �`fr
The forggoing instrument was acknowledge before me
thiZl day Sy �� 20AI by
t . day of , 20VA by
of
CAD
R e)b c.c �I^ d Cft � 21-f
Name of person making statement
Name of person making statement
P rsonally Known OR Produced Identification
Personally Known OR Produced Identification
l'pe of Identification
droduced
Type of Identification
Produced �'L �-
II
Signature of Notaryublic- State of Florida >
(Signature of Nota Public- State of Florida )
ommission No. My"{SSION#GGo22U23
Commission N NNAMgnUENFlS
=r •�*� EXPIRES: December 16, 2Un'U
MY COMMISSIONi� GG 032Ut3 i.
=a: �- EXPIRES:
TW Public Un03[%Veter✓
>rF •'o:•' Bonded Notary
• December 16,
2U20
dadc�wr
««
•«««B
, rs
REVIEWS
FRO T
ZONING
SUPERVISOR
PLANS
VEGETATION
SE
ROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
BATE
(RECEIVED
DATE
COMPLETED
I
Z
8/2/17 1 %A