HomeMy WebLinkAboutBuildng Permit ApplictionALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:9 ] IIPermit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �; 13 U l ,
Legal Description: vy(�1`_A �16N � �7,
Property Tax ID #: � D - t 16 0 - L 1 �) -D 0'�, �, - I Lot No. 61-�:)
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED 'DESCRIPTION OF WORK:
t e- -,v r y
CONSTRUCTION INFORMATION:
Haafcfonai work to be rform
HVAC Gas Tank
OElectric _ Plumbing
Total Sq. Ft of Construction:
under this permit - cl
Das Piping
05prinklers
Cost of Construction: $ a7 t1 . b
OWNER/LESSEE:
Name '� -r 1-r-\ �C i
Address: � �-z'� L
Zip Code: - Fax.
Phone No. �- - ��
E -Mail:
Block No. I .
appy_
Shutters Windows/Doors
Generator Roof Roof pitch
S Ft. of First Floor: _
Utilities:LSewer OSeptic
State: �- L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: 301P t-1 i Z L_lrt-1
Company: Qen PL-".&Ltst eg i
Address: O 5'G- 6o kk-Clv-\ N ,(--
City: pc,f � &-- Ge- State: F - L...
Zip Code: 3 SQ Fax --7-7J -3M-
Phone
3 -Phone No."i `l - 8,
E -Mail: eAesiS (U -0-k bin Cyt} c,41 (Y n
State or County License:��
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN[
Name: _
Address:
City: -
GINEER: � Not Applicable MORTGAGE COMPANY'
Zip. Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
— Not Applicable
Name:
Address:
City:
ZIP: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: __ Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
Not Applicable
State:
Not Applicable
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Please consult with your Home Owners Association and review your deed
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
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
commencingwork or recording our Notice of Commencement.
12
nature of Owner_
64;Contractor as Agent for Ownergnature of Contra�r&onsCili�ar
STATE OF FLORIDA,, STATE OF FLORIDA
COUNTY OF COUNTY OF LAc)j r
The f�going instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 213 11_1 by this 1 day of 20 by
person
(Name of acknowledging) p g� g } (Name of person acknowledging)
Y_
(Signs re o Notary Public- Sta0 of Florida _
} `' (Signature of Notary Public -Skate of Florida }
Personally Known ;,.R*`R" pr Z
° &ARW leh1tAfrUV Personally Known ,.�°.;'r�}t Prcgj 90Le,I�tNR fZ
Type of ldentiflCat Commission # GG 9715D Type of Identificati �°o�`i commission # GG 9715
''7 r, -Iy Omm1551 n X !
r 8� °i t, my Commission XP6r
Commission No. ",,,+i�" Aprl 24 2021 '� r•'��' April (]21
Commission No. "���;' „��'
Revised 07/1512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COL'N
DTFR REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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COMPLETE
INITIALS