HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Oc 6 / Permit Number:
RCIV-
D MAY 2 61017
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 X
PERMIT APPLICATION FOR: a�
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 141 AJt-rr(-t3 BLVD
Legal Description: XIeS j S 11417)0� l/7 C A J/04) If P4 >' 1!�41
y _ 1i A+rg f-71nAr-r- 1 � L'Ovn wrr
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Property
at-,-7 - 7ETProperty Tax ID#: �/�U - �U I - 0 3 'j - Uvv - 9 Lot No.
Site Plan Name: 4 Block No.
Project Name: T
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this perms -check all that appy:
HVAC Gas Tank Das Piping 1J CGenerator
Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Constructio / `t Sq. Ft.of First Floor:
Cost of Construction:$ t70 Utilities: E]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name 6U5AIJ f�, (n)ve4 Name: W f
Address: 139/ 0 Cr Company: N1G°TE2-+ 11200FltiG- LL C.
City: 13i4c1e State:F(- Address: j/��r^ �
ZipCode: 33 y/rP Fax: City: r �h Stater
Phone No. (L&J) &33,3,;&-? Zip code: 3 J q,,6 -7 Fax(, 6 q 303
E-Mail: Phone No. 5&/ 70 7 —0 7 7
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Cc c 13 a?G y a
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SU,PfLEMENTAL 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 or recording our Notice of Commencement.
1� s
Sig;ature of:Owner/Lessee%Contractol4as Agent for-Owner, Signature of Contractor/License Holder
STATE OF FLOJqDA STATE OF FLORA _
COUNTY OF Vj44VI F�Otc64 COUNTY OF 1�a. , V ITS
Theo ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I=ay of � 201 by this 9,CAay of d 20 jJ by
1 S L S ci n tYl - u,'a af)
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public- tate of Florida)
Personally Known OR Prpduced Identification Personally Known OR Prodpced Ientification_
Type of Identification Produced l-DU`IType of Identification Produced 'VL- Vr t J2_; in
r7IN
Commission No.��' ! 3�( ?e ) FRAN EMAR
T1 a Com ission No. ` a - (Seal)
Notary Public.`sate cd. prci3
commissic,"; IT 10:.574
My comm.expires Jan.2 7. OOM
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Revised 07/15/2014 /M! �„ EXP�RESr 19.p$962
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DATE
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INITIALS