HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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S(Permit Number:dumi r
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=RECEIVEDBuilding Permit ApplicationPlanning
and Development ServicesBuilding
and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 \ /--
Phone:(772)462-1553 Fax: (772) 462-1578 Commercial 1�, Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
AddreSI 14 C,i;rvi mrt L �i v'C)
Legal Description: iriQ,SI4wj
Property Tax ID p: ��r�5 - l� - QZ��.. ^ `'�}'�-
Lot No.
Site Plan Name:
Block No.
Project Name: 0%X)
Setbacks Front to() Back:_ Right Side:;J Q Left Side:)`I
DETAILED DESCRIPTION OF WORK:
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O,`l)�>rir<CCZriIN'y
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CONSTRUCTION INFORMATION:
Ad7��itlIwna wor tk oEe a orm`ed under-tNt- permt-c ec a It�a�Iapp—ly
�
LJHVAC Gas Tank []Gas Piping LJ_ Shutters O Windows/Doors
11Electric
G❑Plumbing Sprinklers Generator 1Roof Roof pitch
Total Sq. Ft of Construction:' o& 5 Ft. First JJ )
of Floor.ScC
Cost of Construction: $ S �� e.1
1 Utilities: —Sewer LJSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
_�r
Name C>Ji\ :tsl� p fovJ Name:1tKp(Z(�
Address: k ->kcz1 �.�VJ CD\e� 7 �X; ` CompaL VCt2_c.City:
era7 \fit G�^ State, Addres:K,Ac r7wti d 5
Zip Code: 3r7� Fax:�o`l.ti� J
City: C�<XZi- ,�ti•c.g State:_
Phone No. �oZ � Q a2� Zip Code: Fax:
E-Mail:_ \ e 4 E-4z' 5 n Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail:_, S�p•mL ,[7C�
from the Owner listed above) State or County Licenser �k '11116z;
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _Nat Applicable MORTGAGE COMPANY: Not Applicable
Name: _
Name:
Address: Address:
City: State: _ City: State:
ZiP: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _, Nat Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
winch is inoconWicmt with any applicable lHome Owners Asssociationi ruliesabylaws or antl covenants that may prohibit such
restrictbor
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
In accordance with the approved the Florida Building
plans, Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements
to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender
or an attorney before
comme in work or recordin your Notice of Commen ceme
1 M v OV�
o ner/ essee/Contractor as Agent for Owner
Signatur Contractor/Li rise Ho er
STATE OF FLORIDA��
COUNTYOF I Ar
STATE OF FLORIDA
COUNTY OF_a
The fo_r$oing instrument w s acknowledged before me
this 3Z day of 201Q by
The for Ding instrument was acknowledge before me
thisdayof :nql 2D T by
,N W � ��
�a c'r� wNe r r;.s
Name of person making statement
Personally Known OR Produced Identification _
Name of person making statement
Personally Known OR Produced Identification
Type of Identificat(o
Type of Identification
Produced
Produced 'r-L d L_
�J
(Signs r f Notary Pt�`��(c�5taf�^df'Fib7�'d
66 �fe�•ppt}���e,rt�� EST
Commission No. f'.'_?;�'t ttyr'r114
(Signature o p Iio- St "
::: MYCO M Rd G022023
IRES: Decemper l��6��11�2�020
S51Ci6q�F904578
IDOIkEs;Oo;obr03,
Commission
p3R¢3i'Wiers
'F4Etd1 2019
a���tq,. NNcary
REVIEWS FRONT ZONING SUPERVISOR PLA S VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REV W
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17