HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' �' �� Permit Number:
Building Permit Application JUN 21 2011
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
PRO;POSEE-D IMPROVEMENT,LOCATION.
Address: 990 90 S Gl t%Y1�1•Ur1L' L
Legal Description:
Property Tax ID#: 1301 Ul 1 2 6339 (0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION-
Acid
itional work to be nertormed under this permit—check all
that appy:
DHVAC Gas Tank Gas Pi in OGenerator
Shutters Windows Doors
Pg Mn /0 Electric 0 Plumbing ❑Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$��7 0 D Utilities: Sewer 0 Septic Building Height:
OWNERJLESSEE: CONTRACTOR:
Name G� Name:
Address:D t>5 KA aidrmCcuyit Company: t c��cJl DOCS
City: yse, State: Ft Address: ( �Y 0 (A,
Zip Code• S q q 5Z Fax: City _A State:
Phone No. v�, �i11 - �¢ Zip Code: q'2� Fax: �(D�ZI 52
E-Mail: Phone No. 73262oQ
Fill in fee simple Title Holder on next page(if different E-Mail: iI�CG
from the Owner listed above) State or County License: SSC ))�b`►7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SlJ_2.PLEMENTALOONSTRUCTION" LIEN IAW INFORMATION ;f
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
WARNJNG 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OFft0ruD `0.[<_LJy TIL- STATE OF FLORID
COUNTY OF OIM QQ.i COUNTY OF GL
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1?) day of)(iy\x_ 201:Lby thisIC4 L day of 't✓ 20 f by
IGIAm,e-A A
(Name of person acknowledging) (N of person knowle ng)
r
(Signature of No P lic- tate of+kw%a•) ( 'g ure of t� ic-State of Florida)
PersonallyKnown OR Produced Ident ication ersonall Kno OR Produced Identification
Type of Identification Produced S L_ Type of Identi cation Produced
Commission No. TA14MY ,,OZIRESKI Commission No.
Nutwy Public,(l§FAP of New York RA
No.01K06210638 �NN�fER NAFFgp2810
Commission Expires August 24, ®� ,«o t#0OM July 23,291
Revised 07/15/2014 �xPiFtEs �"Wo 001
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REVIEWS FRONT ZONING SUPERVISOR PLANS VE TATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS