HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ' -I01P-
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
`Pik"O'NO�E1� iiiOKOvtivitN fZOOAT10ir
s.
Address: (4 5 5 N us T,+- -(e-cc_QF L-, Su 9 L L
Legal Description:
Property Tax ID#: 1 '1012- 1 ,3-3,- 0QQQ - ®Q0 i Lot No.
Site Pian Name: Block No.
Project Name: CUQ'CeSS MO\6tke- J-Nyyme, Y--
Setbacks
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QI=WORK j:e1e�'�
I
i
CQNSTRUCTIOWINFORMATION �
Additional work toe nertormed under this permit-check all appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Q windows/Doors
0—Electric 0 Plumbing Sprinklers Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities: . Sewer El Septic Building Height: .
OWNER/LESSEE:' ' CONTRACTOR:
Name 2SS 1plfe. 96LCK- Name: 'FY-CLnC*41% `/.. CCASunD �L
Address: f\) wS Company: Fy (lasar)C> GI-G-Fr1r_al CO'il 6(66( C.
City:- P�- State: 'FL Address:<< I„\ 0 A �1 Xi 2
Zip Code: Rq`i Ll Co- Fax: City: klr _� Re--OLC-y."� State:F(-
Phone No. +:IQ �� - 5 SQA Zip Code: �aCfUC7 Fax: (7-76) Ste_?- FS1S`0
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: tech c_ Cc),N
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I _ s
z,l
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,Wrk or recording our Notice of Commencement.
/ S
Sign of Owner/Lessee/Contractor as Agent for Owner Sign e o Contractor/License Holder
ST7E OF FLQRIDA S TE OF FLORIDA
COUNTY OF fi'�'A1^��S ll UNTY OF ,YY�I�Cit!�
The forgoing instr ent was acknowledged,before me The forgoing instrument was acknowledged before me
this';Q day of 20 � y this a.3. day of cSU� ' 20 �by
�t'C1 1 C_1S c 1., �U r)
(Name of person acknowledging) (Name of person acknowledging)
D�v hA aal
(Signature of N t ry Public-State of Florida) Signature of Notary Public-State of florid
Personally Known OR Prod ced Ide c tion Personally Known _OR'Produced Identification
Type of Identificat'�t8n� Type of Identification Produced
11 ANULLA M HU
lG'RY 8', f a
c&��* •`�- Notary Public
Commission e��QQ��Florida Commission No. Clef O l(¢ o� (Seal)
r •- fission� 94730
� My Comm.Expires May 27.2019
•� ��� one roug c 0 wry u c e oFlorida
Revised 074'322 I4 My Commis annon L Dugan
� y Commission GG 050982
OF
F.icplres 11/28/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS