HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR;APPLICATION TO BE ACCEPTED -7
Date: Permit Number: l D 3 0 3J 0
v
-Building Permit.Applicatian
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 line
PROPOSED IMPROVEMENT LOCATION o-
Address: <A a e? �� S j�aT
Legal Description:lk O&A V 6) Sci.i'it k)e.Y Y4 0'�`�
mod- . . Lu e. ��4)u;vt L .
Property Tax ID#: 232L 3 ^33 3 cJf�G 1 " r:700 Lot No
Site Plan Name: ati �'� C:7R C -`3 �-�3 T- jc_ Block No.
Project Name:
Setbacks Front, IiV Back:,�_'�i_Right Side: �_Left'Sid _
Il/
DETAILED DESCRIPTION OF WORK r
Gtl e-c, b' Lake "CI e-, i:-L_ ew 1,01 4, SiA/U�.il
CONSTRUCTIQN II"INFORMATION t.A
Additionalwork to be nertormed under this permit-check all app y
UHVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
" ElElectric —Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: �� S . Ft.of First Floor: o
`�9 C
Cost of Construction:$ 1 :500 .— , .Utilities: Sewer FISeptic. . Building.Height:
OWNER/LESSEE CONTRACTOR
Name 4 ` i�, 12i� Name: ;4 t'72-s
Address: SS _C e_ Company:
City: Ir--�-• Pie!`Lt? State: Address:fl7 Qvee� ri.-� C�.
Zip Code: 'tiv`I .S Fax: CityStater
Phone No. 2pl' 9(03 Zip Code: TY,9,M Fax:
E-Mail: f �A c4e M" CU 's Phone No. 77a— 332-• M q h
Fill in fee simple Title Holder on next'page(if different E-Mail; SNG r=/obi t�,4'�`r'�►4.-o -Go✓''L
from the Owner listed above) State or County License: Cael-12.1r&g 32—
If
ZIf value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION Y >$
DESIGNER/ENGINEER: MORTGAGE COMPANY: Not-Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: -'Zip: Phone:
FEE SIMPLE TITLE HOPD�,ER: _Not Applicable BONDING COMPANY: Not Applicable
Name: SMAJ z 99lle� '4 Name:
Addre 5eC4 G Address:
City: _ lepc e Ir . City
Zip: - C - '.Phone: 27,2_44,19 -15-i2_ Zip: Phone:.
certify;that no work or installation has commenced prior to the issuance of a permit. _
St.Lucie Counter makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which"is in-con-flict 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 our Notice of Commencement. -
S
§I&Rature of wne ee/Contractor as Agent for Owner Si f Con rise Holder
STATE OF 1RA, STATE OF ORIDA
COU NTY + COUNTY F �.rwr.� .
The forgoing instrument was acknowledged before me The forgoing instrument was,acknowledged before me
this day ofd n L_� 20 12-by this day of 20' by
(Name,of pers acknowle ing) (Name of per acknowledg ).,
(Signature of Notary Public-Stat&of Florida) (Signature of.Notary Public-S e of Florida-)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced — Type of Identification Produced
-
Commission No. (Seal) - . Commission No. (Seal)
y P o,, LASHAHNAINGRAMIJ
Notary Public-State of Florida
Revised 07/15/2014 #'�MY Comm.Expires Dec 20,2018 'r°n `�s: NotarL Pu �ot
iN. 4 = y ublic:
oFa., Commission ,FF_177249 G ,^� °;My Comm.
_. ,�. ._oun National nota y ASS11.E .,F F:` Com fission#UF�� 249REVIEWS FRONT ZONING SI�PERVISOR ' NS VEG` CATI01�a�I SE/>\aTP, ANGROVE
�Y as n ¢„
- COUNTER REVIEW , REVIEW REVIEW REVIEW >; 'REVIEW
DATE
COMPLETE