HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP�,, ED FOR APPLICATION TO BE ACCEPTED s
Date: - )'S Permit Number: / -7
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 1/ Residential
PERMIT APPLICATION FOR:
Address: --1) .
Legal Description:
C:
MAR 2 2018
Property Tax ID #: Y 0 -)- Lot No.
Site Plan Name: (L"C-E 0- Block No.
Project Name: !�AwF
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTION.OF WORK..
a
CONSTRU,CTION11NIFORMATION;
AooitionaiworKtoDeperrormeo unoertnispermit- cnecKall:tnatapply:
-.Mechanical _Gas Tank Gas Piping y r ''Shutters _Windows/Doors
Fw
_! Electric E; _Plumbing _Sprinklers Generator _ Roof Pitch
Total'Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0 D Utilities: —Sewer _Septic Building Height:
.OWNER/LESSEE;
CONTRACTOR:.
Name-7-03;iiV-R F91ccv= irM-
Name: n
Address: S5o� G-QA1-a)64 A-VX
,,,
Company: Nei,) ol-)57L
!12 -
City: t7d- rQIF.4C6 State: FG
Zip Code: ? L(94 7 Fax:
Phone No. *7 72-- °P 7S - (oo 4 (o
Address: 77g4- `i/A/ Alac
ST
City: ct7
Zip Code:
Phone No 779-- a
Stater
Fa�7%�
E-Mail: J"G iM T& Id� 0-0V-LC-4-S'r b N I;f
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 60C
LYr2 /lai
State or County LicenseCC�-
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
$UP;,r; ,LEMENSTRUCTION LIEN -LAW INFQRMATI01,
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name: -
Not Applicable
Address:
Address:
City:
Zip: .;Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name: JUSEaFt 6..
_ Not Applicable
'F•1llAJ��N2 �A-fz-
BONDING COMPANY: _Not
Name:
Applicable
Address: o� Q
l� —
Address:
City: Fi- !pec r-
FL
City:
Zip: 34g4:7 Phone: 772-4-XS--
66
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
commencing work or recording vour Notice of Commencement.
Signatu o Owner/ Lessee/Cdhtractor as Agent foi
eery:
Signaaure of Contractor/License Holder
STATE OF FLORIDA
STATE OF. FLORID
COUNTYOFCOUNTY
OFThe
� 9 s
forgoing instrument was a knowledge before
The fo oing instrument was acknowledge befothis
�1 %J-
19k;
day of 2'/ iZ 20 by
this •day of 1 de C
. 20 by64
/72;) ei'
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]Dt'hnie N-ekt
-
(Name of person acknowledging) N
(Name of person acknowledging)
(Signature of Vary Public- State of Florida)
(Signature of tary Public- State of Florida )
Personally Kno n OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification ee •
(
Type of Identification
Produced &' i^ •
C
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW'
DATE
RECEIVED
Cc,
k/
DATE
n,Q
COMPLETED
Rev.
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