HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
Date:
APLETED FOR APPLICATION TO BE ACCE r D G _
Permit Number:
SCANNED P
BY *� r
Buif6mg;, .t App licationsl,
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Planning and -Development Services Pe .01
—
Building and Code Regulation Division °°iL ,y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _k__� Residenft/oZ.,,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Property Tax ID#: If5I,Id.O-0000-d60-(o Lot No.
Site Plan Name: /rl/+uP2fGIL Gd!&h anu-+1 o a[u f I IBC L-n rr (. Block No.
ProjectName:
Setbacks Front Back: Right Side: Left Side:
Irr��dlion S�Slevn �r\�"a.�iPcQ
riumuundi wurr, iu ue enunneu unuer inrs perm¢-Lnecx an apply:
�HVAC _ Gas Tank ❑Gas Pi ' g _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator � Roof Roof pitch
0
Total Sq. Ft of Construction: S Ft. of First Floor:
ostio�iCon uctio'ri?$ =w n w;.Q .ti' 'es: —Sewer Septic Building Height:
OO WNfR LESSEE
s a e' r�
ate. ;a/ r 5 - N
:CON�TRACROM ..
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Name MAxI6
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Name: m <rll.SackSo i39 3
Address: 'J dal
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aatL
Company: Rixier t�avti(y 'oAr%tncg
(,Le d, ft"-l-
City: VT' P%erc a
Zip Code: 3ugUlL Fax:
-7 Phone No.1 1 t{ s I
Stater
Add ress:3rn�3aN-LL
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City: f-1-\)%efc(
Zip Code: V ct LI& Fax: i7
Phone No. ` ? 9, yb S ^1 I
State -EL
;L(t&")_"( 91
E-Mail: DCa S _ C'&A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: B t%1 -Inc. Cd m
State or County License: Ca tLK
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ENTALCONSTRvJION LIEN LAWINFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Pho
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.
d //tip �(IYI 4� O-�
Signature of ner/ Lest/Contractor as Agent for Owner Signature of Contr or/License Voider
STATE OF FLORIDA ccaap� STATE OF FLORIDA��� yt 6COUNTY OF 0 COUNTY OF ;5�A 11-0-CA SC,
The forgoing instrument was acknowledged before me
this Ilikk I-da_y of � 20� by
-ll I M Ufa f 4 JC�C,�C Q h
Nam f person making statement /
Personally Known OR Produced Identification P
Type of Ide5gificrltion
Produced y een Lice" C' a
(Signature of NotaPy Public- Stat o„ pia a
+Aoti KATHRYNHARPER
,� �olary Public - Slate of Fli
Commission No. CtQOoo io Ca
s" 7Commission#GGI800
�'!rx „!±�• My Comm. Expires Mar 27,
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrprinent was acknowledged before me
this L5+day of 20�by
fp (dDates n
Nameame of pe on on making statement
Personally Known OR Produced Identification
Type of Identification
Produced Dn✓ewes %treks er
of Notary Public -State o
;;`"'�'•`4;° KATHRYN HARP
nNo.alIotaryFuhic- Slaloc
Commission N GG 1
'•.,, �!*!'d My Comm. Expires Mar
S REVIEW R I UPERVISOREV EW I PNSVREVIEW EGETATION I SEATURTANGRO
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