HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:, \1 Permit Number:
• RECEI','-70 FEB 0 6 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
a-'
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
PROPOSED IMPROVEMENT LOCATION:
Address: Z 0.5 Al- #W 1/ f}Pq 7P4- /4rC.2.., EL 3 Lf 91 L9
Legal Description:
Property Tax ID#: 1012 3 /Z4 - oo Jy GOO z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front /s Back: _Right Side: Z Left Side: -7 a
DETAILED DESCRIPTION OF WORK:
IA,,+ai( (Wrtfe dviviewl Concro-e-, sbb ) x25
baa w• e� w� �4�e��Me� No Ve etzk n Wa remov
3 �s -w.-� b sh — �j � no s�l,9 s��u�e. 5
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Q Utilities:ll Sewer E]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Kevl n Li sV _z, Name: rA
Address: 11205- N . Hwy .4i 4 Company: rmt
City: Fb✓4-A6rGe_ State:_EL Address: %Sb 164V_ fwc V.
Zip Code: 1 4 qy9 Fax: City: V(!V.) erc' Stater
Phone No(-1 5-1 SOB—1160 Zip Code: 3Z 161 Fax:
E-Mail:W+1P0 Q 3 (Q VaaIV 3,0004 Phone No. -t?-) 453- 34 34
Fill in fee simple Title Holder on next page(if different E-Mail: COVe ft
from the Owner listed above) State or County License:Cge 2
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 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 rVcording your Notice of Commencement.
i
Signature of OwherLee%C�on [actorasgentrofgrOwnef Sign re of Cont ctor/License Holder
STATE OF FLORID�� STATE OF FLO IDA n
COUNTY OF lm 6yce. COUNTY OF �j���n kuk
The forgoing instrument was acknowledged before me The fo/rgoing instrument was acknowledged before me
this A day of DY l l 20 .-by this O day of X f Q 20 11_by
(Name of person acknowledging) (Name of person acknowledging)
(Signa ure of Notary
�Publ`ic- tate of Florida) ignature of Notary P/ublic-State of Florida)
Personally Known v OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission N!lJ eaGRISELOAARMAS ' ommission Nor �9c56
llAY.t(/9 j,9YPV9 GRISELDAARMA
rj' 6o My COMMISSION#GG0195 5 r°"' °o MY COMMISSION#GG 565
�O Bonded through 1st State Insurance 'F
WIRES:AUG 09,20
°`"`'� Bonded through 1st State Ins ante
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS