HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA qLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ---r—� <
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: /0975 5. ®cean ShId. cJensen Heoch, FL 3519.57
Legal Description:
Property Tax ID #: 4161c?-3,23-
Site
l5/a-3a3-
Site Plan Name:
Project Name: C[IrnberlOnd
Setbacks Front Back:
a&- 000 -
* 955&
Right Side: Left Side:
L DETAILED DESCRIPTION OF WORK:
ge-P1,4c'ejmE r 0F' RzoP Trap .4 "Ulv 175 , QuafJq*ry al= 4Wo W4#zs
EXRc.T (��{q�ry�JT W fTti" v,ViTS 6Yr E4uaG ,�s�n/D� L �lt1f� L��ja�'GI J
S-T�c1c�
CONSTRUCTION INFORMATION:
Additional work tojeperformedunder this permit –check a appy:
I.JHVAC L_I Gas Tank E]Gas Piping _ Shutters Windows/Doors
Electric 11 Plumbing Sprinklers E Generator F Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ r 0� +��0• 1/71 UtilitiesSewer El Septic' Building Height:
Lot No._
Block No.
OW:N'ER/LESSEE:
CONTRACTOR:
Name V59 Mealtq Inc.
Name: .4n An id Riyero
Company" 7-k A. C. Re -rrr 12 era oii n c .
Address: 2906 SIS/ 3r' erra.c e.
Address: /400 Cross inQ ,B/vel.
City: rr0M 1 r14h t2h7 State: _MA
Zip Code: 0!762 Fax:
City: A'eechd6Ce
State: rL
Phone No.
Zip Code: 3,Y974 I Fax:
9&3-7&3-897
E -Mail: y
Phone No. 8G
Fill in fee simple Title Holder on next page"'( if different
E -Mail: fi'Cl GOKe ch o bee tP
yawo- C61"
ounty(cense: p C
I
555,01
from the Owner listed above)
it value of construction is.5Z500 or more, a RECORDED Notice of Commencement is required.
Q
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
Not Applicable
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 thepermit 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 recordine vour Notice of Commencement.
Siglfature of Owner/Leoee/Contractor as Agent for Owner Signature of Contractor/Licensg Holder
f
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF _ L�C�� COUNTY OF
The f r oing inst uu ent was acknowledged before me
this day of, C -A-V-\ 20 L�7by
(Name of person acknowledging)
' 1
(Signature of 4tary Public- State of Florida)
The !f7ing instrument was acknowledge before me
this day of 20 ?by
(Name of person acknowl
(Signature of Notaryoublic- State of Florida )
Personally Known OR Pr?Viced 112ification Personally Known
Type of Identification Produced _L_)' Type of Identification Prod
Com
ANGELA M HUFF
� E commission # FF 234730
Y omm. Expires May 27.''01'
Rr,nr4, „i.
Id
Commission N' .;`SPR�PGe-, ANGELA r 1T_
U*p = Notary Public - State of Florida
)'z Commission u FE
234780
hly Comm. Expires May 27, 2 10 9
?1.._ Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS