HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application MAR I r3 20V
Planning and Development Services PERM. ITTiNG
Building and Code Regulation Division St. Lucie County, FL
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: CqI-� V L ►� �1 I C ( )
Legal Description: 3
Property Tax ID#: S S 5'_ Z- 33 - C o o l r ( 6 0 Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION-
Additional work toe e rme under this permit-c ec a appy:
,HVAC F]Gas Tank Gas Piping _Shutters a Windows/Doors
11 Electric 11 Plumbing HSprinklers �Generator Q Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities Sewero Septic Building Height:
OW N ERAESSEE: CONTRACTOR:
Name ' C "� Name: Z),"eP_✓1�
Address: 5 - eti Company: Z_Or o' r C Vit l Ay'-
�/'
City: 1,s14 I n e t __State: Address: /a !k1_1j/114 Ayr
Zip Code: Z Fax: City: Stater
Phone No. '3 0-7`7 Zip Code: ) "Y7 C/ -7 Fax:
E-Mail: /A_ Phone No. "77Z_-1,'7T -K0-q--7
7Z_-1 0
Fill in fee simple Title Holder on next page(if different E-Mail: LCi G✓ ►''�a - C d/�
from the Owner listed above) State or County Lic se: I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIOW",
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 recording your Notice of Commencement.
s
,7
Signature of Owner/LeA*i/contractor as Agent for Owner Signature of Contractor/Libense Holder
STATE OF FLOR)CIA STATE OF FLORIDA
COUNTY OF COUNTY OF )
The for instrument was Icknowledged before me The forgoing instrument wa acknowledged before me
this day of MArL20 J�by this�day 20 tV_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary` ublic-State of Florida) (Signature of Notary Pub Stiie_d Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type of Identification Produced ";:-1 Type of Identification Produced 111.
Commission NO. mmission No. )"�t
SEN I EISEN
AR N S. N1
KAREN Commission Ift FF 115637
C n M m i ss' m C m s s 1 o 11
My commission Expires R y
June 12, 2-0-18-
June 12, 2018
Revised 07/15/2014 51 ,
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU MANGROVE
REVIEWS COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
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DATE
KAREN
S L
ion IINFIFE 1 15 6 3
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VEGETATION
COMPLETE qERjj: REVIEW