HomeMy WebLinkAboutrevised building permit All APPLICABLE INFO TUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! SJ Permit Number: 6
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:
PROPQSED'INPROVEMENT'.00ATIO
Address: ��1�� i CHARLES WAY LOT 3 AND THAT PART OF SEC 9-36-40
�/ MPDAF: FROM SE COR OF S 1/2 OF S 1/2 OF NE 1/4 OF SE
Legal Descri do .J ! � 1/4 RUN W ALG S LI OF SD 1/4 LI 258 FT TO POB,TH CONT
g p �ON
POB(1.19 ACI 130)OR 3 64421 5: 36 6160 FT,TH S 145 FTi
i .4
y C� ,J
Property Tax ID#: 3 / / �/ a d d I Lot No
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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4, 631 ort�.,�/•<,� A�
�COIV TRUCTION INFORMATfQN
itional work to be performed under this permit–c ec. all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�
Cost of Construction: $jo o Q , vUtilities: —Sewer —Septic Building Height:
OW °ER/LESSEE CON> � T
,
Name �-
Na e
Address: C CU),- Company:
1,
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City: `' State: Address:
Zip'Cod'dr,v +P,! '�� «�� City: Stater'
?ho. <xr d / S— Zip Code: Fax: b
E-Mail: Phone No.�7� — �� -' 0 7 '5__J
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: 6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.CONSTRUCT ION LIEN LAV1/ INFORMATIO3N ,,
L
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 Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLOR144A STATE OF FLORIDA
COUNTY OF cGjt • LV COUNTY OF �.L 1i Q
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 11 day of I.)C)LIOIm � 204 by this day of Lbue mIa air— 2015 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature otar Public-State of Florida) (Signature cif Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identificatio Type of Identification Produced�hL Q COQ
ELIZABETH OLIVO l�
Commission No. Motvyp �f)SteteofFlorida Commission No. d��I�
CO Sim*FF 924719 w ELIZABETH OLIVO
My CWHIL Expires Oct 5,2019 public-State of Florid
����� I 0UnUWUW0U9nfV811PrWrMaryASSn . Can ftsion 0 FF 924719
REVIEWS FRONT ZONIN S P S R PLANS VEGETATION 'a -MCON A1VM@FQ9\PE201
COUNTER REVIEW REVIEW REVIEW REVIEW EV*PMed aryl
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014