HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLJE MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f- Permit Number:
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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 at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: T 1_ C!�-
Legal Description: 't Yui tYL ,i2 Nub !�e4'
Property Tax ID 4: Lot No.
Site Plan Name: Block No. 30
Project Name: r T-7-1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: Gllz_,e_ 4Ci C�IIK6CV g -
3 5 i�? 1 try S - 'i jc i �(a i ram, r��'ZCt��L �.LO
CONSTRUCTION INFORMATION:
Additional work to e erorme un ert isper mit—c ec a appy:
�HVAC Gas Tank []Gas Piping _Shutters I]Windows/Doors
Electric Plumbing OSprinklers I Generator 1:1 Roof Root pitch
Total Sq_ Ft of Construction: Sq. Ft. of First Floor:
C7i 3
Cost of Construction:$ 5 e- — Utilities: 0_Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 6z41__r1,e.1 u f i i Name: LU lqt Lcict I 1p,r�
Address: 33R YUini,Vt:OC,T y-e*_ Company: 1 Y:fCU&tzv-c_ ca S I r
City: P60 P W L ut re— State: t Address: &-'K 14G.0
Zip Code: tlq 0-t Fax: city: -ett -�L ILL �� stater
Phone No. '77�4_ Zbl`C ZfC (p Zip Code: 3( 5 Fax:
E-Mail: Phone No. `TP2•- &Q117'1701
Fill in fee simple Title Holder on next page( if different E-Mail: GCLC—(9Cib C1 Ct 4.1V t
from the Owner listed above) State or County License: CA-C-ok,-E5 V6
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 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.
Signs w6er/1_essee/Contractor as Agent for Owner Signat of tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 1
COUNTY OF ...t-I�,r r`r� COUNTY OF .�_ 0r�rim
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�L day of Ju lut`` 20 (I-by this day of J�t1'i � 20 /7 by
(Name of person acknowledging) (Name of person acknowledging)
J �
(Signat 14e of Notary Public-State of Florida } (Signature U Notary Public-State of'Florida)
Personally Known �� OR Produced Identification Personally Known >/-" OR Produced Identification
Type of Identifica A- Type of Identification Prod
++A;.'ti.. JOY POLLARD ,47"" JOY POLLARD
tit 4"; .+ �eT ^,i
Commission No. i commissioffl G 62174 Commission No. `#� C `la I)sign GG sea 7a
-,� ,,-' My Commission Expires
'n;;a�;°a January 14, 2(121 .,�„� �a My Commission Expires
, �++„� January 14 2021
Revised 07115/2014 wint mom mom
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS