HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 6117 Permit Number: ,1 Da,— dl��
RECEME-D FEB 0 7 2012
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: To Select from dropbox, click arrow at the end of line _�i/��
PROPOSED IMPROVEMENT LOCATION: -
Address:
Legal Description: _�)f/'/iy ;?,o / Ley' Z/
Property Tax ID#: 3 `1v fin- 70Z Lot No.
L
Site Plan Name: '2ewcsS Block No.
Project Name: 2&wl ' cE
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIPTION OF WORK:
.0E�f� /fA��oX..H.��.z-5• 930 LF OF 1.h!'Tv2� FM✓cc A�av�•� i�i� �s�n/o.e�rt, �/i� !.!/�S�"
70k7o vS OF %Hr-/°aoP %/fc /S A-v �Tr/s�7,..6 /°'raTu �Fie�c.o Fwa� O,rr ArkSu.�i6.zxl, �e�L
6F rhi:F, P.¢o &-trS: T/ u/LL Os- %wo AG 'mss aN 76E A477_& ,v 4F 7#' ,
'CQNSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC Ei Gas Tank []Gas Piping D Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers F�Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
2a�
Cost of Construction:$ ,600. Utilities:Sewer 0Septic Building Height:
OWN'E°R�LESSEE: �` CONTRACTOR:
Name AMC1?4--446_ Name:
Address:SjPY6A,,W.t167d2gz,r- St— Company:
City: /oA— S,- lad«- 0- State:oc:L Address:
Zip Code: _SW'3 Fax: City: State:
Phone No. -772 370 -2aY7 Zip Code: Fax:
E-Mail: 26zcS'ou/7,-. .i,-147— Phone No.
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:"
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:
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 thepermit 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.
s
S(gnature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO�tIDA STATE OF FLORIDA
COUNTY OF Sk - \ \y (Z,'\-e, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day of 20 \I-by this day of 20 by
dab--' ,t S .
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary ublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification Produced
"�°�'' DEANNAMARIEWINS
Commission No. .- ° MYCt)fV(1��8i�N#GG 022023 Commission No. (Seal)
EXPIRES:December 16,2020
%;F'o:itq•' Bonded Thru Nota Public Underwriter;
in
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS