HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE I FO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: TI
Permit Number: ��
4
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 I�
PERMIT APPLICATION FOR: To elect from dropbox, click arrow at the end of line
.::. ...:............. .....
P.
PROVENIE
_ROPOSED.IM .N LOC TION :: .
Address: 3 . � S-
Legal Description:
Properly Tax ID#: G �d Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: � Right Side:�_Left Side:
.............:......
DETAILED DESCRIPTION:OF IN:OR ........ .=
COIVSTRIJCTION 11VORMATION:
AOCI
itional work to QMrrornie un ert+ ispermit-check a apply:
y:
HVAC _Gas Tank Gas Piping _Shutters Q Windows/Doors
IJElectric Plumbing EISprinklers ElGenerator ❑Roof
Total Sq. Ft of Construction:
l0 sq. Ft.of First Floor:
Cost of Construction:$--1606 Utilities: Sewer OSeptic Building Height:
O:
WN.ERJLESSEE.:..................,. -
CONTRACTOR .
Name �h i•Moh /176 ` � Name: I?iIG-✓`/,r �S'4l e �
Address: , l y v� Company: /1/C,--A- /'ezSZtlG f i1 E'
City: iiUy) State: I Address: �-
Zip Coder Fax: '�
Citr
y: State:
No.
Phone �` C1yL���
Zip Code: i�2� Fax:
�
E-Mail: (7 au" h
e w Phone No. /
Fill in fee simple Title Holder on Next page(if different E-Mail:
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
SUPPEl1/IE�TALCQ5TRl1CTlL) L >iSLA1N,l9F �i1VIATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: N Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I
I certify that no work or installation has corn enced prior to the issuance of a permit.
St.Lucie County makes no representation t n is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home wners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Ow ers Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requ ed permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the FI rids Building Codes and St.Lucie County Amendments.
The following building permit applications ar 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 tecord a Notice of Commencement may'result in your paying twice for
improvements to your property.A No ice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you inter d to obtain financing,consult with lender or an attorney before
comUienopg woo or record
jpg your IN otice of Commencement.
r
s
_Signature of Owner/Lessee/Agent Si nature of Contrai Kense Holder
STATE OF FLORIDA STATE OF FLORIDA LUC COUNTY OF 'L COUNTY OF
The f oin instru int was acknowled before me The oing instru nt was acknowledged before me
this day of_^ 2 by this day of _,20Y
" �� 1
( e f person ack owledging) (Na a of person acknowled g)
"'e L .............
n e o Public-State of Florida) (Signature of Nota ublic-State of Florida
Personall OR Produced Iden ification Personally Known OR Produced Identification
Type of Identification Produced of identification P uced
Seal a "•frp No. ANGELA M liilat (Seal)
Commis�'ion�Rp,,T AmrFt A M HUFF ( 3�'
4
;'���,`c a Notary Public.State of Florida
y =a�t� �:'-. Notary Public-State of Floridz
Commission It FFrmmisq �
«�-.. A730 � * 4
;Fay Ftfl? Y -mm-Expires May 27,2019
j s; M Comm.Expires May 27,201
Revisets_�6 h1Ai2Q14eJ throg11+Vational�!otary Ass ;i `. Bonded through National Notary Assn. -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
3
INITIALS
1