HomeMy WebLinkAbout1707-0618 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED, h
Date: ` ass'skn Permit Number:' l 1ki • ��7�
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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
PROrP'OSED I,M;PROVEMENT LOCATION
Address: _
Legal Descri ption:,-a(,-van(-\ 10 Loo Or' '39-)Sob
Property Tax ID#: Lot- ` o�^ (��C)^ (7C�' Lot No. a
Site Plan Name: Block No.
Project Name: ��-'C_",'-,Ce-S ``
Setbacks Front_ Back: Right Side: _Left Side:
-DETAILED DESCRIPTIOWOF.WORK. ;,
RepA
.Cs✓ V f
,CONSTRUCTION INFORMATION ,
itio wor to e e orme under t is permit-c ec a app
_HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
Electric Plumbing FISprinkiers 0 Generator Roof Roof_pitch .
Total Sq: Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �) C'o Utilities: _Sewer[]Septic Building Height: .
01NNER/LESSEE: *CONTRACTOR:. : , ..
Name Soca Name: Cb,
Address: Company:br'. ,c rpt L5-:"ecFv,L 'A L-
City: P.-D- L— State:f-l— Address: 4q9_11 LZ) 'P0/'A LDC7 _
Zip Code: '_-)401S Fax: City: epak -1 (�A +N-1 State:
Phone No. _ "��S�l CA3 Zip Code: `ir)47' 0Fax: gal-5$�
E-Mail: r Phone No. as i- ( Cs2 L-a 0
Fill in fee simple Title Holder on next page(if different E-Mai1:UcC \(,�C_P_ etop
from the Owner listed above) State or County License:('rq C Le-)CPQ
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENT AI CQNSTRtJCTION LIEN `AW']NFORMgT10N ' �N
J_. .v. . �,�.<. .
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:
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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 work or recording
our Notice of Commencement.
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SignatL&6 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Lice
STATE OF.FLORIDA STATE OF FLOR DA
COUNTY OF 0("\Ct✓-1-i n COUNTY OF
Thefor oing instrument was acknowledged before me The forgoing instrument las acknowledged before me
this day of 20 j�),by this a�day of AL
20 n by
o n L (1 � 11 ,'1\I n✓�
(VaTe of person acknowledging) (Name of person acknowledge g)
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(tlgnetcrre of Notary Public-State of Flori ) (Signature of Notary Public-;State of FI rida)
Personally Known ✓ OR Produced Identification Personally Known ✓R Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Lel h Dks5W21 (Seal) Commission No.(n(--la,,
� ,� GINA"M`KfNYON
GINA"M_'KENYON :° `� Notary Puplic-Slate of flarr
Notary u_i • ammssion N GG 015542
Revised 07/15/201 Commission GG 015542 as, dk;" My Comm.Expires Jul 25,20
M Comm.Expires Jul 25,2020 ' QF` Bonded through National Notary As
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REVIEWS FR I G SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS '
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