HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 �7 Permit Number: 110 ', dS39
RECEP1-:J APR wA 0
•
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:
PROPOSED;IMPROVEMENT LOCATION:,
Address: 5T-
Legal Description: F_e. iia CS1(L 3 L-04- J-v_(,. C&r`
PropertyTax ID#: Lot No. �-
Site Plan Name: AJ Block No. 3
Project Name: -
Setbacks Front Back: Right Side: Left Side:
DET AILED�DESCRIPTION OF,WORK:..y f
CONSTRU:CTI.ON,'l;N FORMATION.
Additional work to be performed under this permit-check all that appy:
_HVAC _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: 300 t Sq. Ft.of First Floor: )-S-00
Cost of Construction: $ 2_3(90,art7 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE': ; CONTRACTOR:
Name �jlcnn� Name: We-_
Address: 7Wa S-e Blew- l.r\ Company: (3WLJ Cor sfT'JC+)W&-'
City: P_S,1... F-L. State:_ Address: S7.11 A)LJ f i&r- fzrJ '
Zip Code: x`-15fr3 Fax: City: Pc -+ r- . State: F'(-
Phone
'LPhone No. -772-- 475'- S5S'� Zip Code: 3 ('(5 Fax: -77.2-39-3-079--S—
E-Mail:
9-3--079-5
E-Mail: Phone No. -77)-- r�-lS- �75iF
Fill in fee simple Title Holder on next page(if different E-Mail: cQWcil C�-( yc�ti rCt�rA'
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUll LEMIENTA'L CONSTRUCTION�LIEN`LAW INFORMATION: ; ;..
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 pr recording our Notice of Commencement.
s
Signature of Owner/Lessee/Con ctor as Agent for Owner Signature of Contra c /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk. %-%*) COUNTYOF S)c• X-yeA"�,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this"\<P day of '0►R c\' 20 11 by this 2Q52,day ofy 20 D by
W �� v�d� \�o,\ar t C 1wJ V.,IN
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publt State of Florida) (Signature of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Know
Type of Identification Produced �- L_ Type of Identific i, �c tice D Altidal t�vENs
SSIGRI < <
DEANNA MARIE GIVENS k PIRES:Dece r 1 2020
Commission No.\ S _ °;*: 4�@@ MISSION#GG 022023 Commission NO. o Thru Notary � erviriters
EXPIRES:December 16,2020
� o=
O�F���`", Bonded Thru Nota Public Undervniters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS