HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;L1111-7 Permit Number:
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M-0,
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 bine
PROPOSED IMPROVEMENT LOCATION: ,
Address: a:5(n
Legal Description: 5e-. Adf I1A1 a C! rk
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Property Tax ID#: 3q11 ,5qd `• orJ p I Lot No.
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Site Plan Name: (U(1L Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sider j
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DETAILEDAA,DESGRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit-check a a appy:
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❑HVAC I—J Gas Tank Gas Piping ❑_Shutters Windows Doors
11 Electric ElPlumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: '.���}}���//��.. S . Ft. of First Floor:
Cost of Construction:$ `� WO 0 Utilities: —Sewer Septic Building Height:
01AMER/LESS.EE: CONTRACTOR:
Name l�lS 46 Name:
Address. 376 8- Gil -Nunn �w_ 5w 2-00 Company }
City: G44pC'- State:&, Address:
Zip Code: 6a q Fax: City: State:
Phone No. 19113- 6IC7-SK? Zip Code: Fax: -
E-Mail: ( f�2,. c�1M Phone No. ' A5� -a
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Fill in fee simple Title Hol r 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.
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SUPPLEMENTAL•CONSTRUCT,ION LIEN-LAW INFORMATION; '
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:'' Not Applicable
Name:-EcKe-v tt Name:
Address: 2'S O� Address:
City: State: City: I State:
Zip:33g3t Phone: Zip: Phone:
FEE SIMPLE T TLE HOLDEN: Not Applicable BONDING COMPANY: XNot Applicable
Name: ` 0-. LLC. Name:
Address: 37ov W. Sw 200 Address:
City: FL City:
Zip: z3 6C)l Phone: 7 6 17M Zip: Phone: i
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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 reco ding your Notice of Coeement.
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Signature of Owner/Lesse on ctor as Agent for Owner Signature of Co r for/License Holder
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STATE OF FLOR \ STATE OF FLO A
COUNTY OF OU . '�l COUNTY OF' n
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this N'day of C'A�lC� 20 knby this day of m�CC�'' 20 by
J W vv-�vc10n5 �—OY\Ct (-A )LAC k ✓ -)-P� "
(Name of person acknowledging) (Name of person acknowledging)
(Signature tary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known v'l OR Produ
Type of Identification Produced Type of Identification P u RDEN
.�uugy, nE 'I #GG Z
,per►u.',a ion Qices
Commission No. ea If� mission ��• �'. COM-01-Mi.:sior(§
qS LEY H. GUYT pugust,2a, Z
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OMMISSION#FFM
L(407)
13, 2018EXPIRES May Revised 07/15/2014 -0153 FloddaNOtaryS .exom
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS