HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLErrINFOUST COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I� �� Permit Number:
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 _ C
PERMIT APPLICATION FOR: To Select from dropbox, click here
P.ROP�SED;INPR I EMENT LOCATION
Address: 5 5 08 5 ILVETL OD►t 02-.
Legal Description: I W O)AN IZI VE e- 1=-STnTF.5-
PropertyTax ID#: 3g0Z. ca07. OZbz-c)co,co Lot No. 13 AAA lU
Site Plan Name: Block No.
Project Name: I-1C�p3T, L171,WIC'1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORKS r
eE:�PL' -CIG 4 v. I"00ox') nU. I I)MV— w) I r'Ipr\Cr- StZJE_ FCO S tZe
r
y CONSTRUCTION INFORMATION �' _
Additional work to be ertormed under tispermit—check a Sappy.
❑HVAC Gas Tank Gas Piping _Shutters 1z Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ II,Sig Utilities:In Sewer❑Septic Building Height:
QUUNER%LESSEE u 3'w CONTRACTC}R
_,t
Name .4ov75r uuDwtC-7 Name: U_pyNE 'T. .SULNE'l7
Address: 5_508 Sty--Qtz- Opti 1- Company: r-tcVcp14011 ir1Pi?0Ve7MtE7UTr
City: r--OeT PIE?-CE State:FL Address: 'A010 5W. 30 ASE
Zip Code: 34CIBZ Fax: City: 44c)U4L"10oO State: FL_
Phone No. X72- g(0)- SSC�1 Zip Code: 5- 3tz Fax: �Io1 `i'IZ8380
E-Mail: Phone No. cl54-ZQZ414 t5 x 2-,13
Fill in fee simple Title Holder on next page(if different E-Mail: Kv'v""�-5 e Fha Pv0 c("_' - conn
from the Owner listed above) State or County License: mac- C)co t8 q0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SLF P` LEMENTAL CONSTRUCTId.N UEN LAW 1NEC3RMAT{ON .
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 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 our Notice of Comm me
X � i�
Signature of Owner/Agent/Lessee ' nature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5P INS truCl� COUNTY OF Spite L uC�t
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1(o day of JQVI 20M by this ISe dayof Juy 20®by
14 OL75r L DW 1(0 MP�N�2�9 l.�P� N i gU2tJ C—Tr
(Name of er n ac nowledginGoMM�SS�embet UodeNeke me of p rso acknow led ' DAp01��` �EE829219
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7*rR 9�naea g Bon�edfird to pub
Al
ure f Notary Public-Sta orida) ( ur of Notary Publi rida)
Personally nown�OR Produced Identification Personally rnown �` OR Produced Identification
Type of Ide tification Produced Type of Ide tification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED