HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FORrAPPLICATION-TO BE;ACCEPTED
Date:�� ' -'.I 1 Permit Number: omc2-0491-
Building-Peemit
Application JUN
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 1 Residential
Na
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 18� ou V Cv� r�Y i v�� 4 �1/� 1 i
Legal Description: �lS�`�rnC� _- G1F� 4f I tk6 / � �1`� 2�C� 1%r\-A:1, 4 5-k ar-e–
I-A C:o Vv%MC1\ Gly
Property Tax ID#: �t S�z'��'d —C0031^d0�—(A Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Yom.......
" ;'....._ !QS'i r7 l tHT'Ov U t=
f1.v SZ-rt} o Vcau 1 i,3 A—NIP,� Dt-Ai1
ON CI�v N SNI P�Z( bL>::'{ : Y-J-D i ATJ
CONSTRUCTION INFORMATION; j
Additional work to be performed under this permit—check all that appy:
_HVAC _Gas Tank —Gas Piping _Shutters V'--Windows/Do �N�►'T'i��'--S
—Electric —Plumbing —Sprinklers _Generator —Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name e7ki i 6 k LAI - '2._, erL Name:
Address: �,�[ 00 SC'SL��� � r�� � Company:,i,s
City: �C�R\-Ax k`�� �ICWA State:f4--- ddress:/off'/SS'w Afire rfw t.-4 ,chi
Zip Code: 3`x`1 5� Fax: a XCocle:
y: �,rt5'r Lv4.t Stater
Phone No. � �1 -3 Y�?7 Fax: '7 9 -Ga/
E-Mail: (Y f% 5-k'e G y S�r..(&I C,1 N6�ry-i Phone No. J-6 r 7J-:? -3 a8</ tn 13 ,
Fill in fee simple Title Holder on next page(if different E-Mail: S L S Te�_
from the Owner listed above) State or County License: C Cn C_ / JS 7 7 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
rFF,ziPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER:. ,of Applicable MORTGAGE COMPANY: Not Applicable
Name: VA v Name:
Address: KI NIC*1VL0k_F 3W u1r Address:
City: T AL( State: fl- City: State:
Zip: 7AM Phone: OW Zip: Phone: _
FEE SIMP TIT E 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 Coffnmencement 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
comfnencin work recording our Notice'of Commencement`.
$&n ture of Own /Les /Con ractor as Agent for Owner Sign a of C actor/License Holder
STATE OF FLORIDA STATE OF FLORI �Y .
COUNTY OF � > �� N COUNTY OF � .L 1 �
�tU= (A
The fQr oing inst ment was acknowledged befor 7�a The forgoing instrument was acknowledged before m '
this f 3 day of 20 Mby r z this al day of J V�i 261�1_by ;
ui W
0¢
U v
¢�Wv
(Name o.f,person acknowledging) o (Name of Derson acknowledging)14 1
•
'•;; t ;.
.,,,o . ,
(Signature of tary Public-State of Florida) (Signa ry o Notaublic-State of Florida)
Personally Known OR P duced Identification Personally Known OR Produced Identification
Type-of Identification Produced Type of Identification Produced FL Z)L.
Commission No. (Seal) Commission No.�-Tq OLA7I`l (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS -VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW 'REVIEW
DATE ,
COMPLETE
INITIALS
fay.-