HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONj
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
i Date: �i�` Permit Number: l y l V— 0
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ACT
_. L,.61019
"Building Permit Applicatiow,miai,
Planning and Development Services St Lu e e e ty "nt
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 CAR P02 r
PR'?PQSSED IMPROUEM`ENT
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L °CATION �W ` ,.
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Address: �0 Oa IFr� 4 • .3
scription: /7 35 11 L DP ,4jA OF /y Y'a 049 .-vW O/c NL-A/
LegalDescription:
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Property Tax ID #: oZ 3 / 7 - cZA / - OOA 0 Lot No.
Site iPlan Name: Block No.
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Project Name:
Setbacks Front Back Right Side: Left Sider��
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SCANNED
BY
CONSTRUCTIt�N�1NFORMATION� `
Add,itional work to be performed under this permit - check all that apply:
E1HVAC _ Gas Tank ❑Gas Piping Shutters Q Windows/Doors
I
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
63S 0 . Ft. of First Floor:
Total Sq. Ft of Construction: �j
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Cost 'of Construction: $ pis Utilities: L_J Sewer Septic Building Height: y fr
O1NNER/LESSEE,
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ON�R02s �x
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Name L.OR.E.✓ 04U-4 H44
Name: 4wNEQ 61r-
Address: /Q f O /00/1 IrZer le*00(
Company:
City: Fr. PiPrtE State: )O/_
Address:
Zip Code: 3'i�9 �S Fax:
City: State:
Phone No. 7 7-1, - 9 79 _ 01 o9
Zip Code: Fax:
E-Mail: O/i1 a1139.z 00 a) a a/. can
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
fromthe Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
Name: �o n.as Beck/
Address: 405 tv Nam' YO&N ALIE
City: /a.. State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: ! Not Applicable
Name:
Address:
City:
Zi(p: Phone:
MORTGAGE COMPANY: _.L,^ot Applicable
Name:
Address:
City: State:
Zip: Phone:
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.
Thelfollowing 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
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �T• �-c�G/ C
1
The forgoing instrument was acknowledged before me
this J`& day of 20 IC —by
Name of person making statement
Personally Known / OR Produced Identification
Type of Identification
Produc
I
(Signature of Notary Public- State of Florida )
Commission No. a�� r: DIMES )
* * mmtSSW# GG 22 %0
g Expos JUN 24. 2=
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REV REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17