HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO��ac- MUST BE CrOMPLETED FOR APPLICATION TO BE ACCEPTED L'
Date: `� 7—IcPermit Number: 1IfY I -O I- )
RECEIVED
Building Permit Application NOY z 7 eats
Planning and Development Services Permitting Department
Building and Code Regulation Division 5t, Lucie County
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 IMPROVEMENT LOCATION:
Address: %(?n3
P/vIA-105,1
1,,4,✓C r2"k
►P;'er e
Legal Description:
LAhewof2d
PjC h - UNj
//- LLIT
Property Tax ID#: )30/--(,/3'n;L ces-5-oolo-S.— Lot No. 2-0
Site Plan Name: Block No. l 4✓
Project Name:
Setbacks Front I Back: 2— ,o 9 Right Side: 32,/L, Left Side: /Z Y7
DETAILED DESCRIPTION OF WORK:
6w I bww�rlNg 1 001 4- I /}v'er �fc�-�
CONSTRUCTION INFORMATION:
A0ortional worK to be performed un ert ispermit-c ec a apply:
LIHVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing Sprinklers El Generator g Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ L OO o fj 0
S Ft. f First Floor: _
Utilities: _Sewer DSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name V- f M I} f� vT� W
Name:
f
Address: 7o123 i��t�w, o Sia 14/v a
Company: c-/(, a Al US
City:_ r=or� Pi erc(, State:(,
Zip Code: 3raE4.5 I Fax:
Phone No.
Address: Vero 6,94crl n
City: ) /- State:_
Zip Code: 32%�-,-' Fax: ?'72.7'?n-S96/
Phone No. -27a-5-67-3o&7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: De n/(_9 400 F6oIS Iyrc. c d*�_
State or County License: 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con ict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult w th 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 pro rty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. 1111 you intend to obtain financing, consult with lender or an attorney before
as Agent for Owner
STATE OF FLORIDA p STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledged efore me
this 2bday of vJ 20ZJ by
it / //V(99 P
Name of pers n king statement
Personally Known OR Produced Identification
Type of Identification
Produced
• A
(Signature of Notary Public- State of Florida )
Commission No.
REVIEWS I FRONT ZONING
COUNTER REVIEW
Rev.
The for oing Instrument was acknowledged b fore me
this�da of ,wa,) 20�y
ZG/ rr-y t/"- /f
Name oVperson making statement
Personally Known ✓ OR Produced Identification
Type of Identification
(Signature
Commission No.
SUEGETATIEATURTANGRO
PERVISOR
I REVIEW I PLANSV EVI WON I S REVIEWLE I MREV EWVE