HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE 1 FO MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C�L5-1 I �G'j Permit Number: IGC
Building Permit Application
s
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:
Address: LAW POLIrneft -Dri Vee
Legal Description: InCti0d) Viver CS nLfL—LLni+ 05- blk2p W421 Cod 112 22 (M�3��C7rl
Y mm-
Property Tax ID#: Lot No. .�
Site Plan Name: Block No. 2�e �
Project Name: L�eit�rli�h
Setbacks Front ✓ Back: Right Side: Left Side:
..Lastat1 like 11k? 5 Ay-tt)2 r40ar
Additional work to be pertormed under this permit-check 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:$ 2,141p0 Utilities: —Sewer —Septic Building Height:
.� j^`a - ° .ernes '$�,u' d y .r.: „r' t ,.n.w ,a-;�n•eo- - ,n. *,.R.,. ..�;
Nam FA totyr.
,�,,!! Name:`_'01MA na t.-L
Address: t,Um ivt Com an li'l 1 F_oVe yr jse f ertr�r� t� Pri ra �
P Y�
City: �1'-1-pi-'Yrb State:FL Address: 005 7oe"a'h ►c:w1r Dr
Zip Code: Nza Fax: O/A City: ror'U'n P4.,bou. 6e'zc - State: Ff.
Phone No. NIT 231- Zip Code: 3H37 Fax: 3Z1- 777- 423y
E-Mail: tsli_. Phone No. 772-337-411170
Fill in fee simiple Title Holder on next page(if different E-Mail: 6atesSh aun a uko.'.<ar^
from the Owner listed above) State or County License: ijl 1
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
MIR -
"'�'"Y n Y � 0"
F
DESIGNER/ENGINEER: Not Applicable' MORTGAGE COMPANY: Y 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
commengng work or recor .iLig your Notice of Commencement.
Signature of Owner/,Agent/Lessee Signature 4of" ontcactor/License Halder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF r L(QC' COUNTY OF bVL610T
The forgoing instrument was acknowledged before me The forgoing instr-ginent was acknowledged before me
this 'tL—day of y201(p by this Z) day of �,20W by
a person a nowledging) (N a person nowledging)
(S a orafy ublic-State of Florida) Si n e ry P blic-State of Florida)
Pe ona y no Y/ OR Produced Iden if' I Kn n O ]rip giration
Type o t ication Produced ,wi+ _gsootcFazir,Fn _
e o en ' ion Produce
MY COMMISSION B FF 244&55 s.`, . MY COMMISSION N FF 244555
, IRES:Juno25,21Commission No. eai XP
mission'No. 'Z ��'.,, tEflTS:Juno 25,2019
Bonded Thro Notary Pubdc Unde rs „y f„ •• BehYe7 i�Notary Publb UnderwMers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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