HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA E INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J�2
Date: 3 Permit Number: 117n 03 1C)
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
Address:
Legal Description:
Residential
Property Tax ID #: ' 414 - -70 Z - IbO 3 Z - O00 e Z Lot No.�_
Site Plan Name: N �t4vs C --t- _ _ - Block No. z�
Project Name:_- 1N,n1DoLAJ_
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
"--i;> C-) -%J s I
CONSTRUCTION .INFORMATION:
Additional work to be nerformed under this permit- Check all appy:
❑HVAC L___l Gas Tank F]Gas Piping _ Shutters Windows ors
Electric Plumbing Sprinklers ❑ Generator Q Roo Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ �., O cp a
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Named ,2, r,s I—c4 D
Name:<<- 333,S t.. 'iG
Address: ( It, QUP,ens KNAJ LT
City: State: IF -L-
Company: n�N P U i Nc E acs E -g -S
Address: IN -1 Q u erc n,� ekt"." C71
Zip Code: 3 q 3q 9 Fax: dv 04
Phone No. '772- -3'3'2- —f T FA-
City: 'FT State: L
Zip Code: __,:�JCT45 Fax:
Phone No. �t7-,?_ — 57_2--C�i (c,,6
E -Mail: AJ f Ar
Fill in fee simple Title Holder on next page ( if different
E -Mail: S 1AGFLo (L[ a 1- (a YI-Hc4
State or County License: C -RC. 1 ZS �C5:3 Z
from the Owner listed above)
If Value of construction is $2500 or more, p RECORQED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: = Not Applicable
MORTGAGE COMPANY: —,ff'lfot Applicable,
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FSE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _ of Applicable
Name:
Name:
Address:
City:
Address:
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 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 ull 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
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIPQ
COUNTY OF ` 1% i mea'& L -I
The forging instrument was acknowledged before me
this � day of lMwa L 20 Q—by
�o5 L,f P
(Dame of person acknowledging)
(Signature of Notaryublic-State of Florida )
Personally Known OR Produced Idgntification
Type of Identification Produced %-L- Q L
Commission No. FF iiSy'�
Revised 07/1.5/2014
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of
(Name of person acknowledging)
20 _by
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
(Seal) Dertial"I Commission No.
Notary PubrC
My Commission Expires 5/2312020
Commission No. FF 995463
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS