HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 11(J 5
BURWVP�Ak4 lication
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
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Address: fi) dl'f E (2 L_A kle 1) P FT-
Legal
T-Legal Description: 1 ►''� f���L I-d41C�° ST/�T�S L ®T
Property Tax ID#: Q36 — 6 d 1 — 0450 Lot No. _,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DECRIPTION,iOF WORK ry r
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CONSTitUCTIONINFORMATION fr
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it ona wor to e e orme un er t is permit-c ec a appy:
VAC LJ Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
FlElectric 0 Plumbing Sprinklers F]Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ?i��D i Utilities: Sewer Septic Building Height:
QWNWLESSEE CONTRACTOR t
Name L� 4 f (JL/t / Name: A-7 A e A_ f1 �-FANIP
Address: l b- tz
1 T; A14h.ea-I-Ake � - Company: /1-7A
A R e -tA A,-r A- L
City: Er �) 6(2-e'6 State:r—& Address: 11g7 L56 L,4/'1C14L-41U—
Zip Code: 3 V_19 V7 Fax: City: 'RPR_t 7-. LGt-C i*�7 State:
PhoneNo. �J a�- 7 S r'a 7 �Z 7 a. Zip Code: 93 Fax:
E-Mail: Phone No. 7 Tri '0/`0 3 D..
Fill in fee simple Title Holder on next page(if different E-Mail: /t) 17,.
from the Owner listed above) State or County License: `
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5UPPL`EIVIENTAL CQ:NSl"RIJCTIQN UEN3LAUU 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 or recording our Notice of Commencement.
_Signature of Owner/Le ee/Agent Signature of Contractor/License H61der
STATE OF FLORIDA STATE OF LU c � FLORIDA+
COUNTY OF 'Pr . � COUNTY OF �S L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this r� day of J4NSy 20 aby this 5 day of M 15, .20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public State of Florida) (Signature of Nota Publi State of Florida)
Personally Known OR Produced I t' Personally Knowri ProduiMfff
�aR ='
Type of Identification Prype of Identificati e;i cdCo
a� MY COMMISSION#GG 022023 •;s• P December 16,2020
Commission No. — dedThruN
�?` F_ �:December 16,2020 ommission No., "Ieb#c Undenvrlters
'%;off1Bonded Thni Notary Public Underwriters
Revised 07/15/2.014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS