HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y_c2al ' Permit Number: j 4 OZ
RECEA-_D SEP �� 2011
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F134982 /
Phone:(772)462-1553 .Fax:(772)462-1578 Commercial Residential l/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCATION• ., Y = `
Address: 5S 1 1
Legal Description: nck%czrn U',4 09 d311t&a LC i
M 3N/I of --3S-714— I-(19)
Property Tax ID#: 3 yea Cp I D — X35 — DaDQ Lot No.�_
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEl'AILED DESCR{PTION OF WORK
CONSTRUCTIaN_INFORIWIATION, 4 „ ; :� , �_ „ ., _r.
Ac1clitional work tonL
orme un er t s permit—c ec a appy:
'IDHVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
C1Electric0Plumb-Ing ❑Sprinklers MGenerator Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
<a
Cost of Construction:$ 9c5 Utilities: Sewer Septic Building Height:
OWNER/LESSEE .;� _ ? CONTRACTOR '- _ =
Name Name:
Address: 5o It e�nmbno Company: t ALI i Fr 7- i
City: State:,D�_ Address: lC
Zip Code:�: 114%D Fax: City: F7D�A State-_Y-1,
Phone No._�7,9-'SCS I— 1999 Zip Code: 3 449� Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: a LA a I -In e,n G
from the Owner listed above) State or County License: aCe g Cp Cp
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPtEMENTAI.CONSTRUCTION LIEN I.AW INFaRMATIO;Nr
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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Coun#v make no representation that is granting a permit Antill authorize the permit holder to build the subject structure
which Is in conflict wit anYY pplicabie Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult wit 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 thp first insp ion. If you intend to obtain financing,consult with lender or an attorney before
comm n in work r recordin our Notice of Commencement.
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S
Signatu a of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF P,4 . C"i . L COUNTY OFcr,—s2 , L . ',c--
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this��day of s g:C3 . 20 Eby this,2L day of .20 by
(Name of person acknawldgiging) {Name of person acknowledging)
}
(Signature of Notary Pu limo-State of Florida} (Signature of Notary Public-State of Florida}
Personally Known � OR Produced Identification Personally Known�„<6R Produced Identification
Type of identification Produced Type of ldentification Produced
Commission No. Seai) Commission No. @;0—CYo
,r``ti'��°1:�''�, GABRIELLE HICKS11
ra` � ' •'s GABRIELLE HICKS
EXPIRES:F 2,2021 =s, p,= EXPIRES:Febua Z 2021
Revised 07/15/20
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS