HomeMy WebLinkAboutpermit application ALL APPLICAB IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED S ~
Date: Permit Number. V
J1111111 111111111110
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 APPLIel CATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED 1MPROVEMENT"LOCATIQN
Address: a
Legal Description: o
C' G% 3 Y 2 7 tLqf mel-o�' slt�G AT 6E6C_n. Iv► 1",q
tf -'e-_-r 6-"5—C, T m
Property Tax ID#: 1d l- ci` Lot No. dam
Site Plan Name: rS � V,(�1/ Block No. J1
Project Name:
Setbacks Front Back: Right Side:; Left Side:
DETAILED DESCRIPTION OF WORK
4 �4 �d ,�a� CBs
CONSTRUCTION INFORMATION
A itiona wor to je ne Orme J under is permit—c ec a appy:
E3L_l HVAC Gas Tank [—]Gas _Gas Piping - Shutters a Windows/Doors
Electric Q Plumbing 13Sprinklers Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ -60' Utilities: Sewer 0 Septic Building Height:
OWNWLESSEE -_ >CONTRACTOR
Name a c sC o Name: A. C
Address: r�S' Company: i fl211i'L
city: State:,- Address: C 03 E f.
Zip Code: .-- Fax: City: Ff State: PC_
Phone No. C1 ? ? Zip Code•,3 L(q 6�>— z Fax: 7 7 `761v Wig%
E-Mail: Phone No. 4,f
Fill in fee simple 746e Holder on next page(if different E-Mail: ce �O
from the Owner listed above) State or Coun 'cense:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _-Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name'
Address: Address:
City: State' City: State'
T
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address.• Address: T.
City: City;
Zip' • Phone' Trp: Phone-
1 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lude 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 herebVgree that I will,in all respects,perform the work
in accordance wItIfthe 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,screewrooms�and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice-of Commencement may result in yourlaying twice for
improvements to your prgperty.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.if you intend to obtain financing,co ult with lender or an attorney before
commencingoork or recording our Notice of Commence t
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder--
STATE OF FLORIDA STATE OF FLORIDA / r
COUNTY OF �- COUNTY OF
The forgoing instru ent was dmowledo 1 re me his Ing
Y ent as ac k owledOged before me.
this 4 day of 0
CIA 0�"
(Name of person admowletUng) (Name of person acknowledging)
(Signatur N ry Public-State HUFF (Signature ot No ublic State of Florida)
Lp M
A14GI� . state of 4730 11da s ,
Personally Known �+cpoluroed �W�a ersonally Known`� Identification
cation '°` "' CommIss s May 2
° _ ." « F FF
tou hNationa� �,, ?1* Notary ubtic t'
t of
Commission No. '-;;�oFy;° Bona& �), '' Commission No. .t t a; commission( Florida
+ ''' ; ' omm.Ex 34730
'r" Bondedthrough N;,t[ , 27, 2019,
Revised 07/15/2014
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS