HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO UST Btu �� IIVIPLETED FOR APPLICATION TO BE AClcr: ED %�%� , I
Date: — Permit Number: UhJ l ' Q�Si
SCANNED
RECEIVED
Building &Mpplication
Planning and Development Services $f'P 1$ Y01Q
Building and Code Regulation Division FW=72m
2300 Virginia Avenue, Fort Pierce FL 34982, St. Wum�e71t
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_IW_a_C:�
Legal Description:
- v`rL7 f 1 -
Property Tax I D #: - QZ)a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK- �S7�!AXfiV
T GY'N n a ��--}T - e�i s�,�� %
CONSTRUCTION INFORMATION:
ria Olnondr worK w ue Penorrneu unuer uns Per ra-UMLK do dppry:
[1HVAC Ll _Gas Tank �GasPiping _Shutters Windows/Doors
,:E—hlectric Plumbinnng\\ Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: X5c> ^ 5 Ft. of First Floor:
r „
Cost of Construction: $ GOr� Utilities: _ Sewer OSeptic Building Height:
OWNER/LESSEE:
CONTRA TOR:, -
Name k 0
Name:
Address`: 6O O
City: V C�a7r-�o , eci - State:t-L
Zip Code:Jd-C3 (o'� Fax:
Phone No.
Company:
Address: N „ S W 3s
r�
City: -or� ilk_-
Zip Code:S I Fax:
Phone j 0. �i� �- 46(') 11
State.YL
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E-Mail:
CUv1—
State or County License: C_QC61
413�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENGINEER:1 _ Not Applicable MORTGAQ� COMPANY: _ Not Applicable
Name: .—r� I1 Name: �\ Wl
Ad ress: rW-%ClI& v r l,V Address
City. Q=0 a State: L City: State:
Zip: Phone ) - o — Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDINj MNY: _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 tti�e first inspection. If you intend to obtain financing, consult with lender or an attorney before
cot�nclle work or recordine vour Notice of Commencement
W\k��
-Striffru're of Owner/ Lessee/Co tractor as Agent for Owner
f Contract r/Licen a Holder
STATE OF FLORIDA'
� 1.a�
STATE OF FLORIDA,,,,,�
COUNTY OF
COUNTY OF
Th gang instrument was acknowledged before me
7 ing instru ent was acknowledged before me
is ?lay of 20� by
this day of 2t by
Name of per n mak g statement
ame of perso maki statement
Personally Known OR roduced Identification
Personally Known OR 0aduced Identification
Type of I nti cation
Type of Identification
Produced
Ax3a"
Produced I=L
jxf::�
(Sig tur f Notary Public- State of Florida)
igna ure of Notary Public- St of Florida )
Commission No. AHNA INGRAM
Commission No. LAS �tRt4 INGRAM
A NO" Public - State of Floridad1
„rJ� Merry Public • State of Florida
'f �4'CliliR. Expires Dec 2o, 2
M7fbmm. Expires Dec 20, 2(1t 3
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REVIEWS
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PLANS
VEGETA - URfLE
MANGROVE
RE I
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COUNTER
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17