HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 O J -3% / Permit Number: I
=CE
Building Permit Application
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
Address: IiR IJ =-Qtu`a ®CGL.S bitVC.� jwSen-Bme-V1 SCMNED
Legal Description: See a4u..ur e,!. - BY
St Lucie Countv
Property Tax ID #: 44T 11 _ .5-00 - 00 1 Lv - a [l) I Lot No.
Site Plan Name: be-o'ch A-O c-15e- 60,0, I 1 -q LZ-Ci Block No.
Project Name: b'e-OLXh A-0 LC,5 e, 6 CC, II a �-�-
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Setbacks Front 90 -Ff Back: '(p if Right Side: - (0 Left Side: «
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51V13J� gca. c.
1 L_IHVAC
11 Electric
QWindows/Doors
El Plumbing Sprinklers 11 Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5-100
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
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Name&0-0-i t4dw-5e, paG 1(IL-L-C-
Name: e,5k-Pr cC4-,v M611
Company:54x&r+ Fe- Q�oYVLPOLY) �S
Address:.33 cL.(" )' Dr'
City: 54-tA-�4- State: _(-
Zip Code: dlf'/C!% Fax:
Phone No. 57-61 - & 13-- TTZ0
Address: 100 80 14- Q 1n 3(P
City: 54-LL"-� State: FCC
Zip code: '34gL75- Fax: 7'7;j-0-n- 3036'
Phone No.. 7-1-1
E-Mail: I oa+Q 001 A I.I0--h00. GOfYi
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: aol% �
ifIvalue of construction is $2500 or more, a RECORDED Notice of Commencement is
Sk.1PPl1rMENTxAL CONSTFtUCTk
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®ESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_^Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
F,EE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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.
i
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 lender or an attorney before
commencing work or recarding vour Notice of Commencement. _ 1�017
ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF ►rt
The forgging instrument was acknowledged before me
this, dayof 0C4-o hP� 20_ffby
ay—,- fS c (�1 ono-rLeA-
Name of person aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
� e
(Signature of Notary Pub is •
two... o; •., DIANE K BOND
Commission No. 'i ..,I }' MY( WVIISSION #FF1854:
SS December 28, 2o1
(407) 399.0100 r1nr1dt%f4otdNSgNIC6.ccrn
Signft�of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Pl/Vl_
The for�go�'ng instrument was acknowledged before me
this 0`- day of e.I— 20-teby
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
re of
� DIANE I ND
mission No €' a
i COMMISSI N #FF185430
kXi'IRES December 28, 201 a
REVIEWS FRONT ZONING SUPERVISOR PLAPA VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW RE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED ii(7 fro
tev.8/2/17