HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST:BE COMPLETED FOR APPLICATION TO BE ACCEPTED \ t
Date:. Prgr; -7 Permit Number: 11 a d 5_I 1
s = ,� RECEIV'70 APR 272 07
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=T578 COfY mercial Residentialy
PERMIT APPLICATION FOR: To Select from dropbox, click arrow:at the end of line
PROPOSED LMPROVEMENT LOCATION:
Address: 92 �/` A 0 V21 �- 31 (o �- eresz
Legal Description:O ��r'\ooy- S 0��� '. .�J C�v�� '��\i ati UY1)
i o)-:0-re. h CM iw mD}'7 e6 r 31 y S- '06?Q
Property Tax ID#: / 3 S O 1 — 0120 — 0059 -. 7 Lot No.
Site:Plan Name: F—�11u Vt k- Block No.
Project Name: Vt
Setbacks Front. Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.R. '
NSTALt.A'-i DN ncavl-e
T UJ 0.L2-) (VOL v—Vi v-S V2,,o�1
CONSTRUCTION INFORMATION:''
Additional work toa er.orme under this.permit—c ec a appy:
HVAC. r]Gas Tarik E]Gas Piping _Shutters Windows/Doors
Electric ❑ PlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ ;;LH Utilities: Sewer Septic Building Height:
'OWNER/LESSEE: CONTRACTOR:
Name ki c43-) Puvt Name:: c>,Vvl a
Address.: . D �07< ��} Company:
City: State: 6U Address: On
Zip Coder I Zq 1� Fax: City: °�� 2a('�� State: ,
Phone No. :S i g 660V Zip Code: _:?,�Aq5 \ Fax: 7-?1--79Ll-I S qo
E-Mail: Phone No. —7 D 2-- "7`'!(f--
Fill:in fee simple Title Holder on next page(if different.:' E-Mail: .d V Ali Ur i Coy vie sti. erSi CA1'!0
from the Owner listed above) State or County License: Ll-3 4Y.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 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 thepermit 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.
% LLIA elltt� s
Signature of TW66r/Less&/Coritractor as Agent for Owner Sig ature oContractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 Jf COUNTY OF 15*
The forgoing instrument was acknowledged before me The forgoing.instrument was acknowledged before me
this 4
day of P c e20 �—by this , day oft�� 20 by
�1\i 0�rV1 V d►d� ` 0.3�i., �'� i•\4-v�A V a►"^ 1 1�Sti,
(Name of person acknowledging) (Name of person,acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary P blic-State of Florida)
Personally Known OR Produc d Identification P sonally Know Q
NS
Type of Identification Produ a of Identifica g>' edTVPI:RES:
R81a#UIE NEG 02202
..SAY FU D � �
`•`•'�4=._ OMMIssioN#GG 02.202 '�• Decf bar 6,2020
Commission No. $5 -.: (S C mission No. ryl nderwritare
IRES:December 16,202 ta W6F�1et
Public bd��o�r BondedThniNotaryUnde tars
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS