HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.
ALLAP (CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J010 ��
SCANNED Permit Number:
Date: i
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v.� r Building Permit Application
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Pl 'nning and Development Services
Biding and Code Regulation Division
300 Virginia Avenue, Fort Pierce FL 34982
hone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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ERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'PROPOSED IMPROVEMENT LOCATION:
Address: 16 so 64n f i it- U 1 Foy l' Pi c,rt pFes, 3 `lfW S -
Legal. Description: ;I 3S 3'j Fro,, llllt Of S L 1 Of llli N of S VW on,l
90 Ave IUc11 AL& 40 R/v III Ft fo (gob , T�691 ia�Ff A NIr 411.24 1b
Property Tax ID #: % ZZ 41 2 ` 0 00 3 - O D O — Lot No.
/
Site Plan Name: Block No.
Project Name: _ 8 KS R t siarn
Setbacks Front Back: NI Right Side: Q[ Left Side: /V /
DETAILED DESCRIPTION OF WORK:
rt-pim,ce- �ckl`sfin, voci !•p s;dit% w��'► ��d,�.� p��,,� ��,o s� :n�.
CONSTRUCTION INFORMATION: Yo 4j
Additional work to e e orme under this permit- check a apply:
OHVAC E] Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Elenerator Roof Roof pitch
Total Sq. Ft of Construction: /•S . Ft. of First Floor:
Cost of of Construction: $ 4 0'0 Utilities:n Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C@ te.
Name: a SCI
Address: JCS. G p2n4j_Lp Q
Company: ftnJ - G�
City: r-i- Pi er t State:
Address: 2,0 q6 r(ifisurt, &,v- l�z�
Zip Code: _3�A q5; Fax:
City: `r i -0_ _ State:
Phone No. -7i ,;? - C.((o'S - '7 (e (0 3
Zip Code: _n i c'n Fax:
E-Mail:ru ' j �� 1. d tXh4aCX2 -h„ �o
Phone No. %Z "I17 -7
Fill in fee simple Title Holder on next page ( if different
E-Mail: ' &
from the Owner listed above)
State or ounty License: C C SOS i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
N
SUPP
MENTAL CONSTRUCT N LIEN LAW INFORMATION:
DESIG
Name:
Addres'
City:
Zip:
ER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
:
1 State:
Phone
FEE SIR
Name:
Addres
City:
Zip:
PLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
:
Address:
City:
�
11 Phone:
Zip: Phone:
OWNER � CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated'.
I certify tt 11t no work or installation has commenced prior to the issuance of a permit.
I
St. Lucie Ci unty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in' onflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. lease consult with your Home Owners Association and review your deed for any restrictions which may apply.
In conside ation of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accorda ce with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follow rig building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory ructures, 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
improve ents to your property. A Notice of Commencement must be recorded and posted on the jobsite
before t first insp ction. If you intend to obtain financing, consult with lender or an attorney before
com en Ing w rk r&ording your Notice of Commencement.
naturE of Own / L e/Contractor as Agent for Owner Signature of Co or/License Holder
STATE F FLORIDA STATE OF FLORIDA n
COU OF a • L.uue Le, COUNTY OF S t�& CL3 PCUA- )
The forg 1Ig instrument was acknowledged before me
this ay of TU lv . 2oT19 by
N
Type of
3me of person making statement
Known OR Produced Identification
The forgoing inst ent was acknowledged before me
this � dayof r�� 20J by
(amq o (A —A-S5el. L
Name of person making statement
Personally Known OR Produced Identification
Type of Identification > •
Produced I . 0 t2. (it—
of.NotaryPubl(Signature o ry Public- State of Florida )
,r^t>aC"c'� ••,, TAWANDA PINKSTON•CASTRO
n No. ' _ . N lic - State of Florida ,C� I CI''1 �� (� Jean G. Frisson
.:
Commis ion GG099917 Commission No. NOTARY PUBLI
Q; My Comm. Expires May 1, 2021 STATE OF FLO
Borded through National Notary Assn. Ciomrn# GGI97f
J
Expires 5/18!
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iED
Rev. 8/2/1