HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \t 1 �`� ` Permit Number:
RECEM-D NOV 182016
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 V
PERMIT APPLICATION FOR:
PROPOSED PROtfEMENT L0 ATO
Address: E Ipu-;_ Fr E�
Legal Description: IAj- Q_cvew— S; S r�S �'i 7 `L�)_DG� S7 _F f 5
Property Tax ID#: 31102 609, ��� 1d 3 Lot No.
Site Plan Name: Ocs � Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
11 .D:.1- LED
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CO S RUC 10,N INFOR'MATIQN:
AdditionalworKt-o-beperformeclun er t is permit-c ec a tat appy:
_Mechanical _Gas tank ' _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers. _Generator Roof Pitch
Total Sq. Ft of Construction: POO Sq. Ft. of First Floor:
Cost of Construction:$ Z 8Q fl ' Utilities: —Sewer —Septic Building Height:
-SSS' C0 0
Name 1_6.0NywA-�) r Name: Py N �s arll�� ii
Address: Z=��[;--_N�Ca2 `rn?' Company: ' -S,�S.tJ` �or�r-�Uh (lG
City: State: r(- Address: : Z7/ Dl,&
Zip Code: 3419-1 Fax: City: fie?4�-� Stater
Phone No. 727- rf(p(D 0 S-Z Zip Code:3�Qo 2 Fax: �72_
E-Mail: Phone No 77? Z(0 047
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above)' State or County License__�D6�SS"23 Ml
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SlJ'APLEMENTA CONSTR+EJ I®N WIN
LA IN!F®R+MATO
DESIGNER/ENGINEER:- Not Applicable MORTGAGE COMPANY: =Not Applicable
Name: %f4Wk:21 LCgdvr.i/ Name:
Address �_�c� G'r2 Address:
City:SSL Stater City: State:
Zip: ?r 'qzi 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 our property. A Notice of Commencement must be recorded and posted on the jobsite
before the first ' s . If you intend to obtain financing, consult with len or an attorney before
commenci or r rec rdin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Siontractor/License r
STATE OF FLOR DA STATE OF FLORII A Lac S
COUNTY OF !M Lyc�� COUNTY OF y
The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day ofd� , 2019 by this \� day of 20 \6 by
S�c•1�.,n Cgs�a�� ��`I S�e,vt,n Ca►s�o.n� o��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notar Public-State of Florida) (Signature of Notar Public-State of Florida)
Personally Known OR Produced Iden ' Personally Known OR Produced ld _'...:
Type of Identification ENs Type of Identification ;
Produced L fl NA�IEGN 022023 Produced L j�[_�...,,., O��ccION#GG 022.023
MI N# 6.2020 .. •r- �V18{ �W % r
+: COM mget fiats ��yr w(PIRES' m
Commission No. � PIRES' Cunee Commission No.
3s• •' d d uNo 1''•'Eoi.0
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014