HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�(- No 's 1 "�
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Date: �`/�—1 Permit Number:�17Q F ® J
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Building Permit Application PES;,qiT ING
Planning and Development Services Si. Lucie County. Fl-
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:
PRUP�SED INPROVEMENTFOCATION.H
Address: ���`� �i/eS gf✓al LToSew ge.',c�i, -Fygy557
Legal Description: lile.
Property Tax ID#: f-/532 2- - 5-0 I,2 V/- ODQ- 9 Lot No.
Site Plan Name: //eBlock No.
Project Name: A21 105-Y
Setbacks Front Back: Right Side: Left Side:
DELED°DESCRIPTION O: WORK
TAI
4
72.2 �-t ,nabl Aazyc
GONSTRUGT(ON INFQRMATIQN :, y
Additional work to be performed 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: 722 Sq. Ft. of First Floor: Z22
Cost of Construction: $ l700,,,„ Utilities: Xsewer _Septic Building Height: 9�7
T OWNERjI.ESSE .z
:CONTRACTOR
Name, W4 Q d`���%s//ta�/,ems c7 /yl�r �:� Name:
Address: /5 �6 Woodwng, .. Company: . i./ `fh . i�
eim �n i D �rsT ".�LJC.
City: State:; Address: xl,6
Zip Code: gll,ZJ5-9/4/, Fax; City: Jew riti - c State: /CL-
Phone No. 33 6- „2Y,3-12 3.2 Zip Code: 311757 Fax: 772--23 -,2-/9'/
E-Mail: Phone No. 772 - ,W -3715--
Fill in fee simple Title Holder on next page (if different E-Mail: a-1141" S✓n� �! ;'176 1�d f0/ell
from the Owner listed above) State or County License: C86 125-1:71-71
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUFPLEM;ENTAL CONSTRUCTION LIEN LAVs/ 11'O' tMATION.'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: 1, Zi Phone:
FEE SIMPLE TITLE HOLDER: Not Applica 1BONDING COMPANY: Not Applicable
Name: Na
Address: Address:
City: City:
Zip: Pho Zip: Aw e:
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 inspec 'on. If you iDtjqd to obtain financing, consult with lender o an attorne before
commencin k recordi o o ice of Commencement.
Signature of Owner/Agent/Lessee Signat a of Contractor icense Holder
STATE
I�IDA STATE
COUNTOYOFO(�IfY\ (?j2UG� COUNTOYOFO � r�'1 rG�C'J7
The forgoing instrument was acknowledged before me The f rpoing instrument was acknowledged before me
this I G4�ay of JW 1�1 201(p by this I day of U W 201�, by
1��a r✓1 Srn-,�fly ,��;rn `�rn ���
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification_
Type of Identification ProduceEDriVe1'� I + P/Vl�� Type of Identification Prod uced�Y'1V e►'S l i C�F'1 ise
Susan Hold
Commission No. 66116l) Commission No. _ (Seal)
sum, H
STATE OF FLORIDA NOTARY PUBLIC
REVIEWS VF §W/20t SUPERVISOR PLANTURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW RE VIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //2014