HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J p I I
1_13 Date: C,C ' r 1 Permit Number: 1 ` O l0
Building Permit Application Ju36'
Planning and Development Services f�'�f; �if� i<<�^
Building and Code Regulation Division - -•
Si. ?ucfe c.;cui t ,
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 IiVIPROVEMEfVT LOCATI,CN
Address: .�7 9's -beer- "-R" r �-
Legal Description: 6;,o/-R i l rl s a/
Property Tax ID#: l L/D 7 - ICU 1 - D b U S?- y UV - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION :OF WORK
5,e w a-/ i ka -vr_ k i �
CQNSTROCTION INFORMATION s
Add ftfona I work toa nertormed under tis permit-check all appy:
HVAC Gas Tank .❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing O Sprinklers El Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Z(flab Utilities: Sewer E]Septic Building Height:
OWNER/LESS.EE a'„ " CONTRACTOR:.:'
Name 0P r e-n Name.
Address: D 7 4 0 W ►�� Company:13r�,�/es L^n 4- Ino
City: ("A:�j #a T I A_C-\ State: FL Address:: 3S I
Zip,Code: 31.-) L43�(p Fax: City: I State: F�-
Phone No. C_Gis\n D6_ 77a Zip Code: 331q LOU Fax:
E-Mail: 5"3 to Phone No. -/71I, 5-1o? f 7 7 3
Fill in fee simple Title Holder on next page(if different E-Mail: ev b&_11_ ,0y_*, (1,-01
from the Owner listed above) State or County License: C&� )5v? 0.310
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C,O'NSTRUCTION LIEr, LAW INFORMATION:
_
�.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: — of Applicable BONDING COMPANY: 6-16t 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 thesubjectstructure
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.
-71s
Signature of Owner/Lessee/ ontractor as Agent for Owner Signature of Contractor/Licen 96 Holder
STATE OF FLORIDA6� \ ,,, COUNTY FLORIDA �)f
COUNTY OF L G
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 11 Nl-- 20 by this&I dayof 20 by
(Name of person acknowledging,) (Name of person acknowledgin )
(Signature of Notary Public-State of Florida} / (Signature of Notary Public-State of Florida.)
Personally Known OR Produced Identification y Personally Known OR Produced Ide7tification V/
Type of Identification Produced Type Type of Identification Produced FL UK
Commission No. 15(Q� ,,��� ea !<AREN S. NIEL3COJn i Sion No. 9 Leal,1
_
?s Commission;4FF1 5637 11 n���;RYovo' ICARE(�j
mv Commission E pires
wy\;t-_ M ices
�.�o,.= Y Commission Expires
Revised 07/15/2014 _ `" h 12 201 s es
June
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS