HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 � '� Permit Number: ( 5 �C�
•
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: To Select from dropbox, click arrow afi'the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Ia rn o 1 PO � ucA.o FL 3H95&
Legal Description: St1�Qnna Nu-b- PcI_ nom-. 'L,(�`JI , S o+ 3
Property Tax ID#: �L` - -7 d I - C I so ._ O OQJ 2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: d
eve s )1n — } &J-)S oh O_Lw 50 a sh t
CONSTRUCTION INFORMATION:.
Acid itiona I work to be nerformed under t is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters indows/Doors
11 Electric 0 Plumbing Sprinklers FI Generator Roof Roof pitch
Total Sq. Ft of Construction: 'Snc, Sq. Ft.of First Floor:.
Cost of Construction:$ �SCX�.� Utilities: Sewer Septic Building Height:
OWNER/LESSEE; CONTRACTOR:,;
Name 5YJ=1+1 Name: OzSoHti 1 V(� N�
Address: q�aI NMI,(')" Ci (L• Company: I= 1N C.
City: State:F L Address: 1`AO V 3a Dk'�-1 E h w-q
Zip Code:3 H Ct6i Fax: City: S-w Cac Q T State: F L
Phone N .'1n2)AM eQ8co- I y N 9 Zip Code: -Y-kgg y Fax:
E-Mail: nZ �����dil7lC11 • Con Phone No. 7"13 ��a - 44,5 Lk
Fill in fee simple Title Holder on next page(if different E-Mail: 5�yo�'�,�ooh i n9��c Lo Mco.5A, n�e 4
from the Owner listed above) State or County License: CC.L - 03Lq,-1 I I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: I' State:
Zip: Phone: Zip: Phone: '
I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I�
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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner fdenature of Contractor/License Holder
STATE OF FLORIDA(y STATE OF FLORIDA
COUNTY 01 Pi COUNTY OF 5T l
The forgggg"�'n,g instr t was cknowledged before me The forgoing instrument was acknowledged before me
this � day of 20/ this 10ayof P � { 20 t 1 by
(Nam f person acknowledg' g (Name of p son ac w dging)
(Signature of Notary Public-State of Florida) (Sign ure of Notary Public-State of Florida)
Personally Known V" OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.�� -IDs :°`• r�� =- (Seat)ILICIA PORTS Co mission No. ,•opt--y TURNER
my COMMISSION#GGO 1035 _1* _A Commission#FF 922696
n�ojR, EXPIRES November 29 i Ex ires September 30,7019
'•.,,°„;,`5 Oondad Thm Troy Fain Insurance
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE_. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS