HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO/MUS BE COMPLETED FOR APPLICATION TO BE ACCEPTED y�
Date: 9 r� �` . Permit Number:
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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 A—
PERMIT APPLICATION FOR:
yO,P�SE-DrreI.✓NrPR(31�1E1fa caM1000
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Address:
Legal Description: /_i-n-ks 65 �� Vanluz
Property Tax ID#: 31-I�J °-1y� c GDL4&- QCD r g Lot No. Q
Site Plan Name: Block No. L4
Project Name: UGI(-n 6q
Setbacks Front.. Back: Right Side: Left Side:
7.77,77777
DE1"AILED DESCRIPTiOf�}QF WOR14' Mtt �A
�n
CNSTR �CTftllnfftJRM 'TI�N x , v +� � r° Y r° : a � x
itiona wor to a pe r orme under this permit-check all tat appy:
)(Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing —Sprinklers _Generator _Roof
Total Sq.Ft of Construction: ��ll Sq. Ft.of First Floor:
Cost of Construction:$ ?0V Utilities: _Sewer _Septic Building Height: '
OWNER/LESSEE Y xa :, A ',. #Ak . _ CRACTOR•
Name Gk,Qa, curneu Name: (�/�.t- i> Cu, ti _.
Address: Company:f LAm q 3 _-F-513366
City: `mac-�'_ St I_LAj2�e_ State: Address: 7e4_Q eC Y 10�
Zip Code: .3 L4 9 5Q Fax: City:�PL;,ft S-\- l.-t Aci Stater
Phone No. C-7 rl Q- 3 qg-te�'IO I Zip Code: Q Fax:
E-Mail: Phone No b 1� 53
Fill in fee simple,Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License �Pr�` (g 'j -7 Co L(
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
`(�4 x�s;� r-?` �r sa�:.�...�•.�:_re 1 ;� ,s x t• ...��'S=� x 3• "r,r
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 poAV on the jobsite
before the first inspection. If you inten o obtain financing, consult with 11-nder or an arrrney before
commencing wo k or recording our otice of Commencement.
Signature of Owner/Agent/Les a/Contractor Si ature of Cbritna—ctor/License'llolder
STATE OF FLORIDA ) STATE OF FLORIDA
COUNTY OF � •`�1.�---JL4 a COUNTY OF_ S+. Lu G',1
The for ping instrument was acknowledged before me The forgoing instrument was acknowledged before me
this f day of 20-4 by this J—4t ay of 20j,5 by
ma
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Pub/lic-State of Florida)
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identificati Type of Identification
+������ DEBORAH RUSSELL Produced DEBORAH RUSSELL
Produced aY�o'% ,+ «,
o ary Public-State of Florida 20� ���; Notary Public-State of Florida
Commission No. ='°�t•c My Com Ex es Nav 30,2018
SY Commission No. _•: My ComCgires Nov 30,2018
-'�r .
Comm s i # FF 179630 0`; Commission# FF 179630
Bonded through National Notary Assn.
�' ��`�'��, Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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