HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED! iJ i
Date: Permit Number: 1 10 -
......µ _ ...... __ 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 c Residential X
I. I
PERMIT APPLICATION FOR: ;
RaP05ED INPR®UEMENT„ Q:CA�910N ' a '
Address: S .5104th 120Qd ; r .Fj` I' e FL.
L ' Co-} I 0. 0 Ac o� 375 1536
Legal Description: DG1CC�5
Property Tax ID#:
01 q0 — �0�0 "dOd� -0DD ` I Lot No
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
e 'aA l
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STRON INTO M'ATION:
1MW L
Additionalwork to be pertormed under this permit-Check all that appy: I
_Mechanical _Gas Tank _Gas Piping _Shutter) Li Windows/Doors
_Electric _Plumbing _Sprinklers _Generator .Y(Roof
Total Sq. Ft of Construct'on: Sq. Ft. of First Floor:
Cost of Construction: J` Zoo Utilities: —Sewer _II ptic ! Building Height:
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OWNEMR/LESSEE: yCO:NTRAGOR�;
h
tk wx;rx�3tii�. 1tSbiAdt-i Ws a:
Name 305 an
�ad Tit Name:'
Addrs:"77Al. M
esCompany:
�'�
City: I i State: Address:'-/✓' , nw i.60 v
Zip Code: o Fax: City: State
Phone No. Zip Code: 2,>0e)y I Fax:�0 F-eu
E-Mail: fx N OffvdijjaP.cook Phone No 9c!'% J"17'1' 04rZ
Fill in fee simple Title Holder on next page (if different E-Mail 42� 1 c 'A zavr
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from the Owner listed above) State or County License (51G e
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S JURN MEENTAL C®NSTRIUCTI,®N LIEN LAW IN'F®RMATI'®:N:
DESIGNER/ENGI EER: _ Not Applicable MORTGAGE CMPANY: Not Applicable
Name: �o Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITL�i OLDER: _ 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 her 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`an'other 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/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI STATE OF FLORI A
COUNTY OF �Ot/I/VYI l,�/P�( �` COUNTY OF
The for Ing instr ment wa acknowledged-before me The for _
ing instrument w s acknowledged efore me
this day of 20 by this day ofDS4 Ze 204 by
ah
(A 4e4w, ;�W7 -
( ame df perso acknowledging) (Name of person ackno dging)
(Sin a of o ary Public-State of Florida) (Signature of Notary Public-/State of Florida)
tn/
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification _ T pe t'
Produced ELIYA CHARq Pod a . . Nota Public State of Florida
MY COMMISSION#GG000 23
2° a Trevor Gross;
Commission No. ?a., d� Sea11 • My Commission FF 16.8493,
( gARES June 09,2020' C m S �oF� �irg5,n„4„018 eal)
(407)3944153 FlodclallotaryService.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/201