HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO B_ ACCEPTED
Date: Z) 31 "1 -) Permit Number:
;J
11 _J I '11 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, cliq arrow at the end of line'i mow
I PROPOSED IMPROVEMENT LOCATION: j
Address: ? 1 L l( ,(nt q -Ave-
Legal
Ave-L gal Description: L- aXc wood, ?a -a- U ii � Q - 111- 16 S L O I Z
Property Tax ID #: 1 I ^ Cr1 1'-i ' n ol)
Site Plan Name: ��fII
Project Name: -�Iw� aur) v)l I�r= L,,,j wn+?
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
am we. _e )CL l� ,� on 1 m, a J w iY1 a a oL
(q) LQ ice• Lof� wind
Lot No. 2
Block No. 15 V
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit- check all that pp1y:
❑HVAC Gas Tank ❑Gas Piping lul butters Windows/Doors
i;lElectric Plumbing QSprinklers ❑ enerator El Root Roof pitch
Total Sq. Ft of Construction: S FtFt. of First Floor;
Cost of Construction: $ S U D 6 • 0 U utilities: L— SeNer ❑ Septic Building Height:
i
OWNER/LESSEE: J��
Name l Qf leary nt-111 n
Address: 1 p 1 1C En -v-' Lvi Rd -
City: mi i 1 V 11 j.P _ State; -NJ
Zip Code: 00-M Fax;
Phone No. 5i -P a`5 -11(o3
E-Mail:t _� Itn.r f 'LtM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: L�e,('►�1 ll�u`i[,� (J'7
Com pary: Q LQ i1r'1 V1 . Cf
Addreid.Y3
1City:rSt- (✓tAAj_L StaterZip Co�-ICI.93 Fax:
Phone 14o. -1-12- & 2 1.P (.o33)
E -Mail., I t ,r nk -S h4d1 S 0 ") ,f C4'Yl
State or County License: C' -A C.1,5a I
if value of Construction is$ 0 or r� F4946Wotice of Commencement is required. SHAWNA M
BODGE
NOTAPY PUBLIC
t t !~MM#FF131&%
lF�(Mfif tlrM18 S�NOTARyPUBLIC Expires 6/11/2018
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT ON:
DESIGNER/ENGINEER: ✓Not Applicable MORTGAGE COMPANY:
Name: Name:
Address: Address
City: State: City:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: "Not Applicable BONDIII G COMPANY:
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of al permit.
✓ot Applicable
State:
"Not Applicable
St. Lucie County makes no representation that is granting a permit will authori a the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaw 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 th t I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Luci County Amendments.
The following building permit applications are exempt from undergoing a full oncurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and a -,cessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commenc ment may result in your paying twice for
improvements to your property. A Notice of Commencement mu t be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, cons It with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contra or as Agent for Owner mature o Conf tractor License Holder
STATE OF FLORIDA
COUNTY OF !-Aa V'fi'► n
STATE OF FLORIDA
COUNTYCIF�.!'►
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of20 Q_by this 51' J dal of raypy'L I 20 ___L_ by
i rvc M u Yl i s b eAv� i S s am ,err, f
(Name of person acknowledging } L (Jmepe son acknowledging )
� p
e o Nota Public- ate of rida (S' nature of Notary Public- S ate of FI rids } m (ry } Pggrr '� i P Ki own OR Produced Identification J
4ersonally Known `� OR Produced IdentificzSJ Y
`+"'0
Type of Identification Produced
Type of Identification Produced � — Yp E
r Icr1,3/S'�3� (seal)
Commission No.J:r-1 314 (�a11.,,. Commission Vo.
SLIG
LORIDA
Revised 07/15/2014 1836 y 21DA
�'
1l201$
1 C-XPIM 611 WO 18
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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