HomeMy WebLinkAboutBUILDING PERMIT APPLICATION►PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j�-11
ISCANNED Permit Number: I ' D�S-
BY R
4U0
Building Permit Application sr, 81QJB
ning and Development Services �P C ��YojP�t
ling and Code Regulation Division
) Virginia Avenue, Fort Pierce FL 34982
ne: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PE'
MIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.'PROPOSEDI
IMPROVEMENT LOCATION:
Addy;
ss: c2o i RdSeW00C4 Dr, F4- P'erC
Legi
'l•
Description: 5 n da I W gbpi es sh) Bl iG C 04--
C')
Pro Ilerty
Site I
Proj'I
Set'acks
Tax ID #: �Z �U_ �7 -R� 06Q�� - CY)n —_2 Lot No.
Ian Name: Block No.
ct Name: y �S
Front Back: Right Side: Left Side:
DE AILED DESCRIPTION OF WORK:
,pv� �isl-� raa maAv-,o_k -{-o )' r -(o I P1
,, . ale (LZ �M•Cir1•E- rnec,� wu--CQ (zz, fJ .
CONSTRUCTION INFORMATION:
Additiona wor to e e orme under this permit — check a apply:
1 HVAC rl Gas Tank
Electric Plumbing
Tota Sq. Ft of Construction:
Costl i f Construction: $ 90 , h to
❑Gas Piping _ Shutters 11 Windows/Doors
FISprinkiers 11 Generator ZRoof ® Roof pitch
S . Ft. of First Floor:
Utilities: _Sewer Septic Building Height: CN,
01NINER/LESSEE:
CONTRACTOR:
Name
Add Bess:
City:,
Zip Code:
Pho 'le
E-Mil:
Fill i rIi
Cc ro 40,N/0—$
Name:
Company: \ rs "C' .
Address:
City: Stater
Zip Code: ?J�i4 Fax:,%a 281-7-7&3
Phone No. 7 aZT577 a
E-Mail: G•) Cn
�l Wo 0 A r.
,�{
I F 4- P e rC e- State: F L
3y 19 •% Fax:
No. o� �Jl ��o�
fee simple Title Holder on next page (if different
from
the Owner listed above)
State or County I erise: CC052 &!���
If val ',je of construction is $2500 or more, a RECORDED Notice of Commencement is required.
so, PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Name:
Address:
Cit1: State:
City: State:
zip Phone
Zip: Phone:
FEE
SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
1
Address:
Cit
Address:
City:
Phone:
I
Zip: Phone:
Zip'
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I ce + fy that no work or installation has commenced prior to the issuance of a permit.
St. L�cie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whic is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
stru4ure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In co'osideration of the granting of this requested 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 St. Lucie County Amendments.
The fallowing 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
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, consult with lender or an attorney before
comlmencing work or recording your Notice of Commencement.
r f
Signature of Owner essee/Contractor as Agent for Owner Sign re of Contract r/License Holder
ST,IIATE OF FLORI STATE OF FLORID,J,,
CO,IJNTY OF �/L i � COUNTY OF �f V)
The' for oing instru ent was acknowledged before me
this lo'?� day of L 2066y
b- ln(_� I -e5
Name of pe son rAking statement \ /
finally Known OR Produced Identification lS
of Identification .
'i1
at9re of Notary Public- Sta� C I rida )
mission No. Q{ . (Seal)
. ..._---------
The fofgoing instru ent was ackn wledged efore me
this : day of 20 y
NameAperson making statement
Personally Kno _
OR Produced Identification
Type of Identification
Produced
(Signat ire of Notary Public-
-SSia,,tez�f Trida )
Commission No. Calla` a �a�v�,1 JSeal1
40"` REBECCA RESTIFOC A
EXP : May 17,2021
R VIEWS FRONT r�sW PLANS VEGETATION SEAT 'S '
COUNTER REVIEW REVIEW REVIP REVIEW REVIEW R
DATE
RECEIVED
DATE
COMPLETED
Rev. 02/17