HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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: 316%0 N Ally l02 t �0(2-� pieE r_CX—_ t �VL 3M 4q
Legal Description: UNOOKIV�WPM I �J4d 1T
i tin —rat--I , Ir`l'21-- A (2-7 _. ^ Gf n I — i �•..'-7^a1
Property Tax ID #:
Site Plan Name:
Project Name: 'ZEJ li N 7kj '� OZ
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
`li 1PLACe� NIL. �LUM13tN(a V-ITZ-i}�-1\i� �j(� F(y_r5F't: p,
I.1�CE A1.1_ T7a i� � oCco 2� � C�Lou
CONSTRUCTION INFORMATION:
c enuiIIICU unuei MIN Pei nu—aiecxdo dppry:
Gas Tank ❑Gas Piping _ Shutters Zindows/Doors
Plumbing ❑Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: b 1
Cost of Construction: $ (OoI C • VC)
S Ft. of First Floor: _
Utilities: NSewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name V t PfJ
Name: V09_7Et✓T M MC.!- E6S
Address: k-Jam Wt�DP- a:ar CTN
Company:1kMPQ NT JJDMFF 'O'F t T I��l 1t%f�i
City: PA\_JmjE2 State:
S
1
Zip Code: �J ' —1 TJ Fax:
Phone No.Q!5_2 - 21 - 7411
Address: 1% s %11 WI CA
City:1 LUQ.9 State:__V_1W
�f`T �
Zip Code: 346 97— Fax:
Phone No.
E-mail: QUSSnPSS@MCHSI CAM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: QI y�Gi(1 i IrY0YY1f?�QtrF71 ►/AIL �'( DIv1
State or County License: CCaC. V5aQj Gj
I! vame or consuucnon is;-zDuu or more, a KLLUKUtU 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 TITLEHOLDER: _ 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 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
commencina,work or recording your Notice of Commencement...
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF COUNTYOFORIDA
9-T L U C t
STAE OF
ORIDANTYOFLk) CA
C UT
The forgoing instrument was acknowledged before me
OC'
The far oing instr ment was acknowledF�e before me
4Wday U by
this day of eJE20Q, . 20n by
M Mdgf, L1
this of . 201
(2�o- M.Af k�Q3
Name of pe%on making statement
Personally Known X OR Produced'Identification
Name of person making statement
Personally Known G— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur Pu ic- tale of o .IILIL PErre
Nota u tale of Florida )
°r. My COMMIS
CommissionNo.jg�is�55
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17