HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: _ a. Permit Number:
RECEIV`=D MAR 24 7.017
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: 1(i iC o ;I)/),y E56±0 - 121/iii o2-- py g/
Property Tax lD#:�q0 - (O-If) 1�)66 -`� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
(04,,U) r-tp I APC(ci
S166k l J FS c6LA — i rn(SGC
I�-n`n!- � - uv�-!rn C tNs�ckrty Slee( — S/tyirrn AtAore co 4'h is aA(y
CONSTRUCTION INFORMATION:
Additional work to beperformed under t ispermit-cleck all appy:
HVAC Gas Tank ❑Gas PipingnGenerator
Shutters ❑Windows/Doors
11Electric ❑ Plumbing Sprinklers Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
C
Cost of Construction:$ _7LAq), Utilities: _Sewer 0 Septic Building Height:
OWNER/LESSEE: 'CONTRACTOR:
Name � Name:_ P .�rL.y, :�� n56
Address: a
_ Gln . bQ6 Company:
City: �21-e_►-C fie State: Address: i201 �i lf/�r r 574-
Zip Code: Fax: ✓ City: �Fl _ State: LL._
Phone No. ?Xol.. a'3�r! Zip Code: 0(1g83 . Fax:
E-Mail: Phone No. 7-_2 -:•73-4&0 G
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU:PPLEMENTAL CORlSTRtJCTIC}N LIEN: LA [NF4RMAT[t?N
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 our Notice of Commencement.
. !�
��— s
Sign "ure of Owner'Lessee/Contractor as Agent for Owner Sig' ture&96hiractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20 by
-
i/{tr1 L ft ?ir 1 .1 m �T�✓C K I oyl
(Nam of person acknowledging} (Name of person acknowledging)
Sigh atureof Not bli -St lorida) �turf!of Nota ublic-State of Florida)sOR Pro
onally Known duced Identification Personally Know �'' OR Produced Identification
Type of identification Produced Type of Identification Produced
is Public State of Roti aCo ission No.
Commission No. rotpa Se��' {y �pRYpV e
4 Joshua Shane Alberka a° "' -Notary Public State cf Florida
My Commission GG 0208 �$ v Joshua Shane Alae
rim
oano S;P1111"510n GG U 66/78/2026 026879
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER . REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS