HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��". )� Permit Number:
0 atom
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce PL 34982
Phone: (772) 462-1553 Fax: (772) 462-7578 Commercial Residential Ll-�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Sa 1 Ck &M f i S -e alyA
Legal Description: Q't4+f i5 -c,6 28 3S +FO -1[-�+ ,nor}- o'F -2 01
A) 9-q ''Ifl S '531 2E Or- ci (,� �l SLI ) Z4 LY A In Y✓
Property Tax ID#: o�cio2�-701-0DfL(- 0O0-3 Lot No. I
Site Plan Name: Block No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
aao v. L45 ,ov--f
o, . a 5 6r. -,p Put f� C
CONSTRUCTION INFORMATION: !ll
_HVAC _Gas Tank _Gas Piping _Shutters —Windows/Doors
Zlectric _ Plumbing _ Sprinklers —Generator _ Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ig o 0
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name—Z12? L/� - Ho
Name: h
2
Address: 3Sa ( 4tanrl3e givell
Company: ,4wnat-� :Inc
City: a ecu
Zip Code: %492 Fax: A11A
Phone No. of
State:
Address: Wl.W ®rP �.•S l n�
/ .-
V 1
City: �� . el[Q_
Zip Code: d LA a Fax: 4///+-
Phone No. '?7;L- '�J& -
State:
E -Mail: --ire ye2i k "> 9 &)Q 2 qme i LcS1rl
Fill in fee simple Title Holder on next page/(
from the Owner listed above)
if different
E -Mail: 64 --Me M i A C @
State or County License: c7
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
City:
Zip:,
GINEER: Not ApplicableI MORTGAGE COMPANY: _ Not Applicable
Name:
State:
FEE SIMPLE TITLE HOLDEP— _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name- _
Address:
City:_
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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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
as
SfATE'OF FLORIgp ICSTAiEOF FLORIDA
COUNTY OF y4 - LA le.� COUNTY OF 4—' G 2
The forgoing instru nt was acknowledged before me The forgoing Instrument
w acknowledged before me
this day of 120`'�by thisgadayof /r'l .20 1-7 by
c'ka" .r,n tie(-SlIaLi(\ &ebb
(Name of person acknowledging) (Name of person acknowledging)
gnature of Notary Public- State of Florida )
Personally Known L.'� OR Produced Identification
Type of Identification Produced _
Commission No. `'"'"Q,% JAMJ) RAULERSON
Notary Public - Stete of Florida
(?knature of Notary Public -State of Florida
n/Pu)
Personally KnowOR Produced Identification
Type of Identification Produced
Commission No.
M R?ULERSON
�•:;f dam:" My Comm. Eaptres Feb 28, 2020 'o���;•` "°,omission r FF °r�{�
Revised 47/1512 My Comm. F.Pisa Feb 2g5YU
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS