HomeMy WebLinkAboutBuilding Permit Application ,I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j
Date: I7 Permit Number:
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 -De i9Y1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: /9S 5 �'eS'P1Cl� IJC�
Legal Description: S&— Ad--W abfA@l�-61 C11TCSL. j
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Property Tax ID#: JAL IQ -Sq0' 01C)q Lot No.
Site Plan Name: "Wa- Block No.
Project Name: i
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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,CONSTRUCTION INFORMATION
Additional work toa nertormed under this permit-check a appy:
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HVAC I_I Gas Tank ❑Gas Piping _Shutters ❑Windiows/Doors
Electric ❑Plumbing []Sprinklers 0 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
6 '
Cost of Construction:$ �� Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 5w O_ Pows4n,, Name:
Address: 37p X SAlru'IrJ A �57u11e ?_O6 Company: S
City: I dl.0 P K State:F-L Address:
Zip Code: ,33_149 Fax: City: ! State:
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Phone No.-- _Psis 6/0 y6<d5 Zip Code: _::NFax:_3q)'
E-Mail: /,vimwe,A hrcabi41AJ6ukV-e. colts Phone No. -
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C1
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION; j
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Wkv cd Name:
Address: 2'S''5- Y& Suje, '30-SrE Address:
City: State: City: State:
Zip:33g3A Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDEN Not Applicable BONDING COMPANY: XNot Applicable
Name: '5W LLL Name:
Address: 370? W• Swdi&t) A%&—Swk 2-CO Address:
City: L City:
Zip:3340 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. u ' tend to obtain financing, consult with lender or an attorney before
commencing work or r rdingVour Notice of Conum4ricement.
Eskc 2 mqv�
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Signature of O n essee on ctor as Agent for Owner Signature of C tra r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF OCOUNTY OF
Theing instrument was acknowledged before me The forgoing instrument was acknowledgedbeyfore me
forgo
this day of`n'1 Cw�lC�\ 20 Eby this Aa day of���J 20 -'thy
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(Na a of person acknowledging) (Name of person acknowledging)
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(Signature of tary Public-State of Florida) nature of Public-SState of Florida)
Personally Known_X OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. '� '"'e4� S LEY H. GU) f�° mission No. Seal
' HEAT14ER HARDER
'-•' �" MY COMMISSION#FF111 98 .o..�r.,,;�nr
-,7, EXPIFrES may -13, 2011ts
Revised 07/15/2014 (407)398-0153 FloddallotaryService.com %+;F o,��.,.` My Commission Expir,Aur:us1 ?8. 2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS