HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETEa FOR APPLICATION TO BE ACCEPTED
Date:_ CylA 1� _ Permit Number: (�j�^
'.:il.":y }a.Y_•ii:,. ..aH9:�_ii::ilA.J1:Et I V D
�:�: av:.''�rs°:c4>:•::re�:a« Building hermit Application FEB 0 8 201 '
PERMITTING
Planning and Development Services
Mudding and Code Regulation Pivisiu�, St. Lucie County, FL
2900 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462^1553 Fax: (772)462-•1578 Commercial Residential
PERMIT APPLICATION FUR: To Select from dropbox, click arrow at the end of line
—:•t:.......r„rw-....., ... ...n...-r:..:., ... ...,. ....: , .'..:.".:.:. n•i. .l f T4:..11 :•4t::•v �:1�'.: iY�a'—
/�� �,�( ' ' �. ... ... .:. :.,:•.-.,.. ,.' 4.•,r;. .t..`, rj:;s� iii}}: ,:,:i�: ';IFf•.: '.!i:= •-,5.;;-'.'+:'''
{ f •�6•y .i 11:x•• ,y:•=:�';'
Address: ��
Legal
Property Tax ID#:
l -oo'a 4-600 -7 Lot No
Block No•
Site Plan Name.•
Project Name:
Setbacks Front _ Back: Right Side: _ Left Side:
T 901
K
. „
Additipna wor o e e Orme un er IF-lb Nc r mit—el' c a A app y:
HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator D Roof Root pitch
Total Sq. Ft of Construction: - S . Ft.of First Floor:
U r �
Cost of Construction:$ . a Utilities: Sewer I_l Septic Building Height:
- ;,;. ..•
•;:, .FST
'raCT
Namp�" tv.,y RfG`trti2�' _
Name:
Address: Company:SP__2vie-z
c1ty:Pgg -, .11.t?. _• State:XP Address: D
State: t,(
Zip Code:�i�L I, K?c1t Fax: City: - 94
Phone No. � a d� zip code: 3714
Fa-
.51.1-71f
x:
Phone No. � +(}I� .Leh cf7
$�
E-Mail:
Fill in fee simple Title Holier on next page(if different E-Mail:
from the Owner listed above) I State or County License 1 -�
if value of construction is$25UU or more,a RECORDED Notice of commenccmcnt is required.
:.Y '•}.yin 'i7,- t•.4'. ...t.i i't•i :,.�:n�h'/"
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ��G Not Applicable
Name: Name:
Address: Address:
City: -- State: City: State:
Zip: _Phone: Zip: Phone:
FEE SiMPLE TITLE HOLDER: _fNot Applicable BONDING COMPANY: :! Not Applicable
Name' Name:
Address: Address:
City: city:
Zip: Phone: Zip: Phone:
t certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie CountY maltea no representation that is granting a permit will authorize the ermit holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or anr�covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
in ronsideration of the granting of this requested permit, I do hereby agree that i will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and 5t.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review;room additions,
actesbtuy pit u(Avres,swimming pools,fences,walls,signs,screen rooms 9nd accessory uses to anrithpr non-residential use
WARNING TO OWNER.,Your failure to Record a Notice of Commencement may result in your Paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. it you intend to obtain financing,consult with lender or an attorney before
commecin work or recording your Notice of Commencement, _—
s
signat of Own Lessee/Contractor as Agent for Owner Signature of Co tactor/License Holder
STATE OF FL {DA j�n� r ` [,� - STATE OF RID
COUNTY of ` -(!j� .�( j counlTY OF
The for Ding instru n_t as acknowledged before me The forgoing instrument was acknowledged before me
this ria)of�Inp—i• 20 L iY this`$ day of �^(-_D iLi0r_lt ,20 LJ by
1
(Name of person acknowl dging) (Name of person acknowledging)
� � m
n
_ &XA ,1 a vmiCCB
(Signa ure of Notary Publi -56&of Florida) (Signature of Notary Public-state of Florida) o � a >
a
Personally Known :jt Persona ly M9,tyurz..I, --wffR•f e�fls acLtc ion 2
Type of Identification r ucAd Type of difllel�c`a' on PeAIRftH& 0 s m
:: l.:J •.�7Y�1 - z
re `` EY,P(. ^e tenitaer 20,201 q;* MY r..nA7Mib810ry rFF + •�' Frfrsw
Commission No. _ • ,..cFr�� ' fl p Commi i4q �' .20
� tp
407)398-n, ' t:c nt 'Nclar09rvtcr,.com r„ ��Ttember 2 2017 �• •" z
(R07)3x8.0153 Ftar"�dalloen r '� 1'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW RFVIFW REVIEW REVIEW REVIEW REVIEW
DATE _
COMPLETE
INITIALS