HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMP ED FOR APPLICATION TO BE ACCEPTED
Date: Permit g umber:
W;
RECEIVED
Building Permit Application oEr.la:lote
Planning and Development Services permitting Department
Building and Code Regulation Division county
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR: Fuel
Address:u-2,Hla Amin; Drile, For-4 'erLQ. F� .349�►
BY
Legal Description: C1f3 Ounty
Property Tax ID #: I4M - -401 - 0049 - 000 - 5 Lot No.
Block No. �J
Site Plan Name:
Project Name: 01:I0- (79.5 5 Si<M
Setbacks Front ) Back: 10 Right Side: 10 Left Side: I O
13gr� $Or7 g�uon d�'x �.nd (vn 9aS )irrE_+}v J'"rKlesS w�� hel.irY� SPa
h2e.?w', ado S,wb� ta1No) hose Swb d� y�s rw.ye A.,d dr�¢i', r►�1;e gas
Gonnevl'� o nS.
`.�.+��iw}}wr�Orle�rtR�sl�C�1�. x j-'w ±{.. r...�t "f•. v..� ,.. ...i'....�t+.'. �-.... � ..d ca,:.r nt. +_-t ..
Additional wor to 0S.WFIC11111cul e...... ec a appy:
]HVAC Gas Tank Gas Piping n Shutters ❑ Windows/Doors
[JElectric 0Plumbing ❑Sprinklers �Generatoi Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ %S (o7 •40 Utilities:0Sewer USeptic Building Height:
Na Doru ld (s Ilinkl2^' N
Name Name: LarryLicasAme as -
Address: 7JQ )iunk AV"fie Company:
City: Fna P,ecce State: Address: 3301 CleanderAve
FL
Zip Code: %! Fax, City: Fort Pierce State.
Lb
Phone No. W, - 528 "Z 9 Zip Code: 34982 Fax: V2465.8448
Onk4kie C? �It$ov ,n0� Phone No.772-633-0740
E-Mail: Brian.Pearl amed as.com
Fill in fee simple Title Holder on next page (if different E-Mail: � 02707/28579
from the Owner listed above) State or County license:
If value mf construction is $2500 or mare, a RECORDED Notice of Commencement is Rquired.
5SUPQLEMENf ,UPQNSTRUCTIQiV,UEN.LAW]I ,ORMATION,
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 lict 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
WA TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemelrqour property. A Notice of Commencengent.
recorded and posted on the jobsite
be a the f st insp ion. If you intend to obtain financtwit ender or an attorney before
co 'enci k or recording your Notice of Comment
Signa ure of 0 er/ Lessee/Contractor as Agent for Owner
Holder
STATE ORIDA
=FLOContractor/License
RID��
COUNTY OF
COUNTY OF l ��
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledg%before me
this � day of oct� r, 20 l� by
this day of \V� S—. 20 by
� t�4rf
Name of pers n making statement
Name of pe on aking statement
Personally Known OR Produced Identification
Personally Known
Type of Identificatid
of Ftorioa
Type of Identification J*'=Boarp,
yr ro Notary Public State of Florida
Pr u d e
Pr ced 4P
lA4Boore
Commission GG190609
G 1906oeMy
'
bjw�oExpires 02/Q7/2022-,
4:2
(Si o otary Public- State of Florida )
(Signature of Notary Public- State of Florida )
Commission No.Qg�S (Seal)
Commission NdCZf=%c10G<�R (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17