HomeMy WebLinkAboutBUILDING PERMIT ALL APPUCVALEANF0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12' 7 Permit Number:
f 1
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 K
PERMIT APPUCATION FOR: lTo Select from dropbox, click arrow at the end
of line
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Address:1LU 6 tF 11 }Zcy
Legal Description:SC.h i \'Q c4 S/n �'hac f, 1 o* 3
Property Tax ID#: b 0 b- 9 Lot No.-_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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me un er sperm -c ec a apply. '
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers C Generator Roof Roof pitch
Total Sq.Ft of Construction: 5 . Ft.of First Floor:
Cost of Construction:$ 'A I U95-00 Utilitles:nSewerUSeptic Building Height:
NanieJ Broh41P Name:
Address. 1$ LEb -PVlib-Cx Company: g %MC5.`1}��aiv�,jj
city:F-f-_ Fi PY( ? Stater Address:Zh5Ll N ljlC
Zip Code: 3Li 61!f S Fax: City: f-} . {7I excx, State:lrL
Phone No.`t t Z - LI It 1- 21 1$ Zip Code:31(G1_4 lr Fax:-T-7 7--4 to% . %J ZZ
E-Mail: Phone No._'1 12- L.1 0 l B'1 '11
Fill in fee simple Title Holder on nept page(If different E-Mail:Y�hA 10 9Yi ox reap 1 r
from the Owner listed above) State or County License:
Ifvalue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:'
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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
commencing work or recording y�your Notice of Commencement.
/.12 s
nature of Owner/Lessee/Contractor as Agent for Owner S' ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST - L_I I C 1 L- COUNTY OF CT - LM 1 C_ t l-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L day of Ain 20 _by thislz day of1A(2 LA,s� 20 —!aby
J FM F G��{fncC 1hMEs. F C-).P-1 MES
(Name of person acknowledging) (Name of person acknowledging)
_45ignature of Notary Public-State of Floridd) Signature of Notary Public-State of Florida
Personally KnowrlN_,__� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifica on Produced
•;p;:?; .,: SUSAN MONTEN =I --
,,�y�
Commission No. "�• t MYCOMV✓N�#GG089099 Commission No. HM;EGRG
i EXPIRES:APN 2.2021 ON#GG 089MBMdM Tr,N NOmY Py*UndV0005ri12.2021 Puck Unde+wnt.R
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS