HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (011(, V-1 Permit Number:
t
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 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: IZ( >t �t/fn/-�/.i �Li,rt PSL rl_ 3cIel?3
Legal Description:RaYi! P(✓k - unit- 5 V511-- Li -l' LCT 1,4
Property Tax ID #: 3`+111 - 5`f 0 - 0151 -COD--7 Lot No.-
Site Plan Name: Block No.
ProjectName: �/ �� nnunC LOn$ �YIAC�1
Setbacks Front Back: Right Side: LeftSidw.
DETAILED DESCRIPTION OF WORK:
Rt? 1 L,Ce Z +un 61c- s yS 1-� W) F, 01 � cam, . I S «r ) 5 Kw
(-,2CI cr. fZeP16,C',,� C1019fe(".
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit -check all that apply: (�
HVAC Lj Gas Tank []Gas Piping IU Shutters ❑ Windows/Doors L
Electric 1:1 Plumbing Sprinklers E Generator Roof
Total Sq. Ft of Construction: ''-f S� of First Floor:
II
Cost of Construction: $ ` L4 (o � G Utilities: Sewer _Septic Building Height:
OWNER/LESSEE:
NameNj,6 i (to iG C+. J TAS4;nk (6SLI
Address: 3v`f(0 Slenr,J'C 6kwl
City: lFbi t- R r /C -e State: EL
Zip Code: 3 `t Ct k 2. Fax:
Phone No. i l TZ) 5�1C1 50i -L
E-mail: 11��g�AOnnCf �CIN�Gi1 Cory,
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
CONTRACTOR:
Name: IYt/✓111 Y_ .-Z/Iet2
Company: Pric 9 Wt-L—P 6/w, -K
Address: `f�1 S6
City: PS L State:
Zip Code: ' f 1X Fax:
Phone No. (772) 41-L 32-0-2-
E -Mail: 6f'lordf_SIe AC PXw2/FSQ 401- (pnn
State or County License: i A( 19 1 i � tl IO
If value of construction Is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
7XNot
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
X, 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 con ict 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 finarcing, consult with lender or an attorney before
,pommencinQ wor t1 re ldine vour Notice of Commencement.
Signature of O�ner/ Lessee/AeSignature of Contractor/License Holder
STATE OF FLORIDA - .
COUNTY OF 1-- Lucke
The forg 'ng instrum nt was acknowledged before me
this �' Iiay of �kn..A 20 11 by
1'.4"licIn611 L_-P_V,-,-(-
(Name of person acknowledging I
,iiii D. (I-,
(Signature of Notary Public- State of Florida I
STATE OF FLORI
COUNTY - I- L/tAcl C
The forgoing instrument was acknowledged before me
this IS'Hayof /1An.P .20 L—Lby
Dc,��.s I�Uz-1�Fz
(Name of person acknowledging I
(Sighature of Notary Public -State of Florida I
Personally Known OR Pr on� Personally Known OR Produced Identification
Type Identification Produced pe of Identification Produced
ffj L I ._ik Wea
MY COMMISSION #FF994 � D. CHISHOLM
Commission No. I)EXPIRES: MAY 18, 2020 Omn iSaiOn NO. � u ( ?��r' NIV COMSSION#FP994358
Bonded through let State I�Itl81 EXPIRES: MAY 1 B, 2020
Bonded through 1st State IMuranee
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS