HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL
Date:
INFO MUST BE COMPLETED r�iit APPLICATION TO BE ACCEPTED I"`Q
SCANNED Permit Number:
�� EIVED
. Pe Stiffing DeOpu
Building Permit Application �u�f, art nr
Planni and Development Services
Buildin and Code Regulation Division
2300 rginia Avenue, Fort Pierce FL 34982
Phon k (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
O
PROP SED IMPROVEMENT LOCATION:
Addre4 (olt5 N Coconut Ave �W Q-Yt_ 3V952
Legal D Iscription: Qav, - Un i l0l- /7 d �y�.?2/✓�
Proper TaxID#: ���(a- S��-C3(�� �Cic�-� Lot No.
Site Pla Name, Block No. _
Project Name:
Setbaq, s Front Back: Right Side: Left Side:
DETA LED DESCRIPTION OF WORK:
u-n VL U t) ou_-W
CON TRUCTION INFORMATION:
Additi nal work to be nertormed under this permit -check all that apply:
1 I VAC L_J Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
lectric 0 Plumbing OSprinklers Generator[N�Toof Roof pitch
Total S . Ft of Construction: 0 S S . Ft. of First Floor:
o�
Cost o'' Construction: $ fGj 543 Utilities: IlSewerFleptic Building Height: �J
OW
'ER/LESSEE:
CONTRACTOR:
Name Sctrbo► a T i '`G
Name:
S
Addre s: (.w N Colr o�nvI- fit
Company:
City: . �. State:
Address:') (
- 0 I'
Zip C de: 3hq ITZ Fax:
City: ' _
State:74_
Phon No. 77a '35q- 0(02q
Zip Code: -12A6?q Fax:77
v? 0137 M 3
E-Ma':
Phone No. ?7
D 1
Fill in ee simple Title Holder on next page ( if different
E-Mail:
(r . CDC
from �e Owner listed above)
State or County Li
nse: CCC O��6
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPP
I EMENTAL CONSTRUCTION LIE LAW INFORMATION:
DESIG
Name
Address:
City:
Zip:
1 ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
State:
I Phone
I
FEE SI
Named
Addr
City.
Zip:
PLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
is:
I
Phone:
I
Zip: Phone:
OWNE�/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify hat 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 'n 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 eration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accor ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foil wing building permit applications are exempt from undergoing a full concurrency review: room additions,
accesso structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN NG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improments 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
Commncing work or recording vour Notice of Commencement.
Sl -a1 �eiof-Qwne /Lessee/Contracto s Agent for Owner Sign ure of Contra r/License Holder
COUSTANTY
OFFLORIDp/�`V) STATE OF COUNTYOFO A4-10
COU ,, TY OF //iV/((
The fo going instrumel was
this daJ� - \.4
y of
Name of person ma
Perso ally Known C
Type if Identifictioo7-),—
Produced
REVIEW!
DAT
RECEIVED
DAT
COM LET
Rev. 8/ , /17
cno ledged before me
F�, 20IR by
!C
Uco
tatement
duced Identification
F Notary Public- State
No. qtov
FRONT I ZONING
COUNTER I REVIEW
The fo,rg$oing instrum nt was acknowledged before me
this K day of 201!E-7by
Name of p rson making statement
Personally Known OR Produced Identification
Type of Ident}fVqtjern �,r,-.::,
ature,bf Notary Public- State of
#EBECCA I_ � 11 mission No. 1 agEC(5�$*ZSTIFO
''[Y COMMISSION fl7 My COMMISSION # GG91863
1= y _ EXPIRES: May 17, 2021
S REVIEWOR I REVI W I VREVIEWON I SEREV EWLE I MREVIEWVE