HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:WVAW
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 here
PROPOS;ED'INPRO. EMENTS LOCATION r,.,, i�I�., ,
Address: ItPSd 1����i/u�` P�IC FOP-7- Agn,��G 3Y1r7 r7
Legal Description:
Property Tax ID#: 093D,;L 'oso-000"9 Lot No. C:�d00,
Site Plan Name: Block No.
Project Name:
Setbacks Front I Back: Right Side: Left Side:
DETAILED OR
DESCRIPTION OEfi WK
GWD a+snraQ #30 26 4
40 IV
CONSTRUCTION INFOR,MATION: .:
Additional work to (ever ori e under tis permit-checka appy: ��
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ® Roof S2 7
Total Sq. Ft of Construction: i /? T S . Ft. of First Floor:
q f
Cost of Construction: $ 14- /3�•Gd Utilities: _Sewer❑Septic Building Height:
OWNER/LESSEE ` .1 CONTRA�"TOR: j
,,,,yyam� � .. _ ,
Name Ci�ll�{c5 1� d Name:
Address: )(OST TWIMPUI+4E DP V45 Company: OAO INfI'Z-RO6r[A)67
City: ro PT Plj�—a6C7 State: F7L- Address: 1(pot C09 N16YUXR' clku!'
Zip Code: 3 -Fax: City: op_f'��/ "COE State: rt__Phone"No. 7� 7al'9Q(57 74�rd j Zip Code: 3 L19'79 Fax:_ f799-33S-�ZS
E-Mail: Phone No. - 2mo
Fill in fee simple Title Holder on next page (if different E-Mail: 4-_S7n7d/7 m •Cam
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
SUPPLEMENTAL CONSTRUCTION LIE=N 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-7"-
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
161rtify 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
coM.pncing work or recording our tice of Commencement. -'!
_15ignature of Owner L ss a/Agent Signature of Contracto /Licen Holder
STATE OF FLORIDA / '' / STATE OF FLORIDA
COUNTY OF �—(�l�i/6 COUNTY OF s7 L4C 1
The for o11*�g instrume t s acknowledge fore me The for of instrument was acknowledged before me
this, may of 20� by this;)Way of 14PP— L 20 �by
CM/,9 T JD7Y1VSJ4) bm f
(Name of person acknowledging) (Name of person acknowled
Signature of-No r Pu lic-State of Florida ) (Signature of Not6/y Public-State of Florida)
Personally Known OR�Prod ced Identific tion Personally Known /Y_OR Produced Identification
Type of Identification Produced Type of Identification Prot7duced
Cc nmission No. / (Seal) Commission No. (Seal)
* ra 'PAT Notary u
P"' Notary'Public State of Florida r Kimla J Simon
Revised 0 /� 4 Klmla J Simone < My commission FF 981331
My Commission FF 981 , ?^ o� Expires 05/18/2020
orr�o Expires 5/18/2020 5
REVIEWS ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS