HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE'. ,.IPLETED FOR APPLICATION TO BE ACCEP D
Date: I I �a1 11 b)unoO PSM 1, rlulnber. 11 , - a 5 S6
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Building Permit ApplicationL 1 2011
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Planning and Development Services
Building and Code Regulation Division
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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 %�q
PROPOSED IMPROVEMENT LOCATION:
Address: %H 3 2 5 u S d—
Legal Description: S f J
Property Tax ID #: O SO —Z Lot No.
Site Plan Name: Block No.
Project Name: po bye V f A-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under t-checkispermit a apply:
OHVAC LJGasTank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers El Generator ID Roof Roof pitch
Total Sq. Ft of Construction l`L �> 2 f e� 'fit` SqI F�t.I of First Floor:
Cost of Construction: $ 23 S G . o o Utilities: I�Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Xfiols _�-l�-ic plc-
Name: 9^', �P�RO v9:o L�SAGiC
_
Address: 3x1 Sw AOr A, 5tNr,2 ✓3Lvv:;o
Company: 51 G 1J v „n�cTf�n-I
City: State: F L
Address: I o 2 2`� 'e� L �� , �� ✓�cA
City:. State.)_N'
Zip Code: L -Fax:------ - —
Phone No. Zo I — 7 Sr-?(f
Zip Code: '3 `f J6S—L Fax:
E-Mail:
Phone No. _3-3 S-244�f (
Fill in fee simple Title Holder on next page (if different
E-Mail: '5 I G N Z O n r 2 r- �-`G n PSG Q ILI-
State or County License: 'hc-� I �o
from the Owner listed above)
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If value of construction is $2500 or more, a REC RDED Notice of Commencement is required.
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SUPPLEMENTAL CONST
ION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Namel'J, W.OAC'% v.
Address i L't" Sr�_
City: Oa—\— State: r L
Zip: -314 q 11Y Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
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 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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF S LUGi 'e—, COUNTY OF Lt 1CiG
The for oing instrument was acknowledged before me
this Iday of iS DJ . 20JI by
Qko artt I Z04-fball
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
The fgnYinstrum as acknowledged re me
this May _ , 20J-1by
QCM r d' (AtlIdba (L.
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
(Signature of Notary Ikuk<
(Signature of Notary I'MIC
Commission No.
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EOreeae(1 08810
Commission No.Cj
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PLANS
VEGETATION -
COUNTER
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DATE
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RECEIVED
DATE
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COMPLETED
Rev. 8/2/17
Notary P.Oft Stets of Florida
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Expires Oft?/2021
ATURTLE I MANGROVE
REVIEW REVIEW