HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED { fpJ
Dat :- \ Permit Number: ! U01 ZI
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By
Building Permit Application stLUcl,9Count,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED] M,PROVEM ENT LOCATION:
Addrel s: - .,Ia \ �\:`� ~ V s- r P i Se 0 (-t, 2
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Legal Description: v e I- 0. 5 C-)- � 0 v ?5 \ 0XIeN Op\3.13-7
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Property Tax ID #: � CZ,� '-no S!qil - 00 n - l o Lot No. E_
Site Plan Name: e_ 'moo Block No.
Project Name: -
1 1-0
Setbacks Front Back: Right Side: Left Side:
DETAIILED ,DESCRIPTION OF WORK:
C,-,�-
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CONSTRUCTION INFORMATION:
Additional
�work to e0 e orme under this permit— check a apply: VAC
Gas Tank Gas Piping _ Shutters Windows Door ❑ pg ❑ / s
❑ Electric - 0 Plumbing Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: '-A 0 S . Ft. of First Floor:
Cost of Construction: $ i�� Utilities: Sewer ®Septic Building Height:
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OWNER/LESSEE:
CONTRACTOR:
Name
Address:�i V�\ler ��- I' �p
Name: R
Comp ny:
City:n r- p Z-e t"ce- State: �= -L
Zip Code: Z4q 2� k Fax:
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Address: t
City 2 State:_
Phone No.(--)-, I� � 5 r 4y `L.k
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E-Mail:!�f
Fill in fee der on next page (if different
Zip Code:'J'4Ll 5 0 Fax:
Phone No.
E-Mail:
from the Owner listed above)
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State or Coun ce se: 5
u vamc ui WFIbLU won 15 ;?c,uu or more, a 1ILLUKUtU Notice or commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
` _,�
`'�
Address:
City: State:
Zip: Phone:
City o State: 1ti= L-
Zip:l?)NA2 L Phone(r-t-I�D
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City..
Zip: l Phone:
I
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that 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 in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration 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 following 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 lend�r or an attorney before
commencing work nr rdcording your Notice of Commencement.
Signature of Ov ner/ Lessek/�ontractor as Agent for Owner I Signature of
STATEbf-FLORIDA `
COUNTY OF
The for oing instrument was acknowledged before me
this ay of G 201b by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
Holder
ATE OF FLO IDA
- , Lv e
The f�g instrument was acknowledged before me
this y of 20-L-b by
�� o s Q 2O1:e.z
Name of person making statement
Personally Known OR Produced Identification
Type of Identification_
(S' /IIissri
tue of Notaly PubliUState fflo ida 0,natQrelpf Nota PUblic- Stat of FloridaF'Jason Hen { yry g�oon No. � {gal)COMMISSION # FF 9 misNoff���0a�-�,°o� �'p� al, Jason
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fco•, o. EXPIRES: February 213, 2019 COMMISSION # F
ellwww.AARoNNOTAR .COM EXPIRES: February
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLET
Rev. 8/2/17
?019
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