HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I�1 I'1 Permit Number:l�d5-d X33
RECEIVED MAY 10 2011
M __
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: Window/door
PROPOSED IMPROVEMENT.LOCATION:
Address: q(,c,6 Aread)o Re)e•
Legal Description: 2L-,1 c6 7DIA i n -I I ai-I- 1 U_)! ! C De -1-3 x.53
Property Tax ID#:_� � )(c^ l'6 D t1�•666 -2 Lot No._�
Site Plan Name: Block No. 1Lo
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION;
Additional work to be performed under t ispermit-check all that appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ (/1, J 00 Utilities: _Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Nameis-rJ 4 M&ry �� �.ro " Name:
Address: Company: ` 2B R_ cyil�rS.Ls�G
City: ; C-I? State: Address: ['Lot JW _al)fyn6re_ St
Zip Code: Fax: City: �,qL_
State:-F:(-
Phone
tate: !-L.Phone No. '72,2-6-1 q " 2(4(P,T Zip Code: Mg 5 Fax:
E-Mail: Phone No. -zJC-C�
Fill in fee simple Title Holder on next page(if different E-Mail:�j cc)a j(/J;-2,�c / iters•C`G/�t
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION,:,,-,,.- .,.
MORTGAGE COMPANY:
DESIGNER/ENGINEER: _Not Applicable Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEESIMPLE 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 Comm enceme .
� .�. S
nature of Own /Lessee/Agent Si ture of Contra to License Holder
ATE OF FLORIDA 4/ATE OF FLORIDA
COUNTY OF S'i i`uea COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 10 day of M!LN1 20 Eby this 10 day of ML i 20 " by
(Name of person a i (Name of person acknowledging)
ro Y°&eL� Notary Public State of Florida =-,_ State of Florida
Joshua Shane Albericoe Alberico
c` My Commission GG 020879
(Signature of Not - t rl (Signature of Notaryulfl` at ;WgIdentification
Personally Known 1/OR Produced Identification Personally Known OR Produced
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS