HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application JUL f 3 op
Planning and Development Services h��`'!
Building and Code Regulation Division Sr. Lj+cin C-C
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 �Q
PROPOSED IMPROVEMENT LOCATION F
Address: 6�Co
Legal Description: i1y1Y1JN AlViCeZ Etc,&ZXVIV17D 2 64le 7_
In P .3 a� D/� �2 - i&13
Property Tax ID#:3�O 2- - 60 c9 - d 3S-2- ®O o _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:-
0v67n x I /r r 1 IVC
CONSTRUCTION INFORMATION
Additional work to be erformed under tispermit-check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator LItJ Roof Roof pitch
Total Sq. Ft of Construction: _ _2 16 S Ft.of First Floor: , D t .o
Cost of Construction:$ {- (? P� Utilities:M Sewer Septic Building Height:1
OWNER/LESSEE CONTRACTOR
,
Name ` Name: r° 15-.
Address: 1 b (a �1 ,,,.� A Company: D v a 14 A AA 13-9011-if- rz S . IlJc
City: o,. ��c o � State:_E_ Address: ('1-1 �a-! C �LT -11 r A r R-�R N
Zip Code:75,"�I a Fax: City: W I L L 1106'
T 0P-) State:_�_L
Phone No. ���r— �(� p .�
`� 1 r� a� Zi Code: �-I Fax. i+q I `1,1 -1
E-Mail: � , A I un �,�.�Ih`6 15. �a-� Phone No.( r�, L 1 3
Fill in fee simple Title Holder on next page if different E-Mail:_- -i 0 tip fol U r11 c4,M jM ;Yaa, COPI
from the Owner listed above) State or County License:C-C,C 1 1
If value of construction is$2500 or more,-,a RECORDED Notice of Commencement is required.
SUPPLE.MENTAL,CONSTRUCTION:LIEN'LAW INFORMATION.;
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
commencini work or recording our Notice of Commencement.
S
Signature of n essee/Contractor as Agent for Owner SIR Kre—of re-ofContractor/Li a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si;- Cc, COUNTY OF ffglAf &.ecli
The forgoing instrument as acknowledged before me The forgoing instrument was acknowledged before me
this-[3-day of_% 20 aby this-c—day of 7111V 120 17 by
IF
- A ,e1�lA wl
(Name of person acknowledging) (Name of person acknowledging)
T
(S' nature of Notary Public-State of Flor da) (Signature o Notary Public-State of Florida)
Personal) Known R Produced Identification Personally Known OR Produced Identification ✓
ype of Identification Prod a -e o�Identification Produced 9r;V�f
OAMAR 0. WAHAJ FG�jGS',�s' Seal
Commission No. '?� = C mission No.
.:(fly Public-State of Flor da
My Comm. Expires 0ct 24,2 18 ��� �(�f�y' ALEX
L 100 ,�fi�OF FL�p•� C� ^�::'ih'L
=N�• b�:
EXPIRES:Febmiy23,212
Revised 07/15/2014
�F�tg`• Bonded Tbru Notary PubHo Undw iters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS