HomeMy WebLinkAboutBuilding Permit Application ALL,APPLICABLE�INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:w,�-x�--- Permit Number: VW)1' 01-3 c�i
, .f _ FECEIV D 3UL 4 2017
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- - 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
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Address: J =
Legal Description: �.}�, Q�,, r. V•n:�"
Property Tax ID#: 'S3�-. 000V'_ OOD-Dl Lot No.
Site Plan Name: Block No• ,�,
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwor to �e ertormea under this permit-checK all t=appy:
AC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq, Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
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Name I,, Cv��$,�_ Name:
Address: 4573 3 5S A Ate- Company: Crt cA-r Nxr&c_r3-r_r s
City: %�-- L-Q,.;-e. State: 711 Address: 5'45' Nw n trsc.ra,3_�1c. A 3-Ts 117
Zip Code: 3LtRP3 Fax: City: q45'- �V(_, 'e- State: F(
Phone No. 7 Zip Code: 341196 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: CV6 5 @, (A r»e H cc,n o•'.r ccnrey, c,*,n
from the owner listed above) State or County License: C_&C 05r7 012. 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY• _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 1 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
impro ements to your property.A Notice of Commencement must be riagorded and posted on the jobsite
bef a rst inspection. If you intend to obtain financin cos lender or an attorney before
co work or recording our Notice of Commence
s
_Signature of Owner/Lessee/Agent Sig ture of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S.*,, L Jc c COUNTY OF
The forgoing instrument was acknowledgebefore me The forgoing instrument was acknowledged before me
this \O day o#3•�\ 20 by this NO day of 75%��:1 20 by
C1nt�Sllroilr.�t Sa►,rf.{ qC^ C.�.{�s�o P�e�• �.�¢�ta��
(Name of person acknowledging) (Name of person ack owledging)
(Signature of Notary lic-State of Florida) (Signature of Notaryublic-State of Florida)
Personally Known OR Produ d Identification Personally Known ti
Type of Identification Pr > �`��?''•: N
Type of Identification �.
-•`��" °4 A MARIE EINENG
5*c yF_ Y COMMISSION#�
MY C MIdISSION#GG 022023 ;a;, EX GG 022023
Commission No. alb �-Z F�yp december 16,2020 Commission No. �5 oP,.• ,��Cember16,2020
'�.fOF�,1�i`• Bonded Thr+Notary Publie Undenvritsrr Bonded T}�N Notary public Undemeter,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS