HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' `gz- l / Permit Number:
RECEIV.70 JAIL 2 4 7017
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: - `c
PROP®-" D 1NPR
BOB LOCATION:
Address: 0 11 f ce i rv, trCC Ff. 3�
Legal Description: 3GI C la0l 002.3 000F
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'ET ILD ESS`•RIP lawn Wt�R3
" fete con
CO 5TRU'CTION INFORMATION:
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 Pitch
Total Sq:Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ f! lJ�l'J0 ' Utilities: —Sewer _Septic Building Height:
�V1 0bbON Rb
Name LU,` d"92cia!` . -dAfr;` v,'2. Name: aVtrh I ` mo. IS.
Address: 20'16- SW 1I Art IiIES 09 IVUI Company:
City: Pmt State: Address:
Zip Code: 3g ly� Fax: City: oi4 e E Cho(�e e State: l`�
Phone No. 1'7a- 1 " O� /� Zip Code: Zef q rl 2- Fax:
E-Mail: Phone No F(93-6-3Y 17 63
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S'UPP'LEMENTAL CO'N'STR�UC�ftON LIEN LAW INF4RMATL®N.
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/L ssee/ ntractor s- gent for wner Signature of Contract r/Li Kse Holde
STATE OF DA STATE Of FLORI
COUNTY OF COUNT OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_Q4 day of c ,-., ,��.�`r� 20� by this,-)_14 day of �20_L_a by
o.1J P'n �!Q SYy1C'\\S �g V P rh P UY1 , lS
(Name of person acknowledging) (Name of person acknowledging)
lZI-ZLZ L�Z�
(Signature of Notary Public-State Florida) (Signature of Notary Public-State of F rida )
Personally Known OR P orilJ.ac d e of a 'o Personally Known OR Produced IcJen ifDAYALA'
Type of Identificatio BRISEIDA AYALA Type of Identification BRISEID
�°PAY PUe` ' `'`PpY v`B�'� P iblic ida
Produced �: Notary Public-State of Florida Produced
My Comm.Expires Sep 22,2017 �; 4; My Comm. Expir017
Commission No. ;I `,* � Cnmm( )# FF 056387 Commission No. N° `_o Commi(sSiiea
-;o,*`;
Bended Through National Notary Assn. ' „, Bonded Through Nssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014