HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION77
r
k
w�5..� _ is
Address: &)l2tig-n:� 0 'f=Ejk-2r _-�
Legal Description:):3 5� 3f] S %z AC-C,9' 61E 72. or- Ii 2 Ozr- o� Z. /-J(i= /'J CJ `cf
Property Tax ID#: 23 ( s 129 86010 'OtA h Lot No.
Site Plan Name: _ (ze Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
r
r s�3.
DETAILED DESC R1PT�ION OF WORK F �,
_ _ _ ,� ,.€- ,;tri v.
Tb GP�v t% AcNi.b P.Q��( c�� i 1n�sG c,•s(� �,� ' cL � ��. (�i�
Additional work to be perrormed un er this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator '(Roof
Total Sq. Ft of Construction: R 6V Sq. Ft.of First Floor:
Cost of Construction:$ Z q0P sw Utilities: —Sewer —Septic �Building He1ght,___
a x i t f �` '�5 i+r 3 dt s z rem - r
OWN ",,R,, LE �. � d ' :,z CONTRA OR
e,.
Name Name: P=
Address: 111 / u Company: LUl.'22 -cNcE,- 0 1.
City: IP State: Address: -K7_-'1"L 0(o6,s-l;>�A%J&
Zip Code: u�.�� , Fax: City: f�c State
Phone No. 77Z ' S�77 D ( (E tD Zip Coder ULCt _L2 Fax: %b)
E-Mail: Phone No "Z-11-2, c-Uo 9aq:!7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 10
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
1
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION
�. I
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address:---2—as- S c_w&r_L)c Address:
City: tPS L_ State: 5LL, City: State:
Zip:�aq qJ - , 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 i e do you intend to obtain financing, consult with le or n attorney before
commenci4g work ecor,Ing your Notice of Commencement.
Signature of Owner/Lessee/Agent Signatu Contractor nse Holder
n
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ���-�\`�- COUNTY OF ssL, LLI �,`Q-
The f9�oing instr e t was acknowled d before me The for ing instru ent w s acknowledged before me
this oC-day of 20�by thisday of 261='S7 by
(Name of person ac wledgin ) 11 1 (Name of person c nowledging)
3::te_�Je b CQ�k6w��o l..l.CIL
(Signature of Notary Public-State of Florida) otary Public-State of Florida)
Personally. P0PARI�g9# ion Persona , nown OR Produced Identification
o e i = Notary PUbllc-State of Fforlda Type of en , {�
l • CommlSSloa#F Produc P ;., ANGELA M HUFF
Produced , 34730 u c-State of Florida
.•
a ;.�f OF fpP•`;- y omm.'Expires Kay-27.2019 "Pr :• Com�ilssioll_#f FF 2347oBea
Bonded throe h National
Commissio 9 )sn Commi i4 oP,� GAM
es May°;;;,,�•` y 27,2019
Bonded W04 Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.