HomeMy WebLinkAboutBuilding Permit Application ii'
TAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number ���'lJVl
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 t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 4a(14 2 CaA Pq 1 M fie`s til(—
Legal Description:Q('`a(yke- 19ekin 131K
Property Tax lD t aLi a t '"�a 000c l`ow Lot No. Cf
Site Plan Name: Block No.
Project Name: cbc- "n
Setbacks Front Back: Right Side: Left Side:
4
Add
itiona I-work to (e ne#Orme under this permit—c ec a appy:
HVAC L_1 Gas Tank ❑Gas Piping _Shutters awindows/Doors
Electric 0 Plumbing Sprinklers OlGenerator Roof
Total Sq.Ft of Construction: Sq. of First Floor:
Cost of Construction:$ Utilities:[]'Sewer In�!Septic Building Height:
lgllh
Name C6 n Name: ..y lickt-.,`St�d�_
Address: 2 q 01' eco Yq I YlYq(rte C)- ,V e Company. 4__Cn Q_
City: Fort Q► c?,:-cz, State: Address: 1 SLf tg�
Zip Code:3 Liq Pa Fax: City: 10,.,`f-iw�2r'S State: L-
Phone No. ?� � ��1 _ 5�7�ai Zip code:3SL1 I a_ Fax: 5-+i=l
E-Mail: Phone No. lam/- �'S`� 4-10:5-
Fill
-(05Fill in fee simple Title Holder on next page(if different E-Mail: �^;
from the Owner listed above) State or County License: �� 1- C- ()� c��3 '
!f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i s �9 '
DESN'-Sm
IGNER/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 County makes no representation that is granting a permit will authorize thepermit 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 anyirestrictions 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.
i
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 jobtite
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.
"�Signature'ot Owner/Lessee/Agent , ignature of Contractor/License Holder
STATE OF FLORIDA S kk_Lc.tl_ STATE OF FLORI A '
COUNTY OF (.. - .���' COUNTY OF Irk 11 __
The forgoing instrument was acknowledged before me The for ping instrumet was
, SPacknowledged before me
this // day of �� A 20 j_by this day of 20 by
lel�l-1 n lio- re lin e �n oo-,ii
e of person acknowledging) (Name of person acknowledging),
SanaGi wf hotz '' u61'sL orate of Ficiritla" (Signa of N ary Pu c-State"of Florida)
Personally Known ORP • t' i at'ion.,-_ Personally Known__ZOR Produced Identification
Type of Identification Produced _ _ yam' f Identification Prod ed, AnrFE AVOUNG
i No" ,Sbtg Of ��,�, %� * Is1Y COid�'JSSION k FF 951069
1 $ TM Seal: 12.2014
Commission No. i fission Na. '_ FXpIFi . )
C efrrtt sloii F�1
011 8*Ire8duly S,2098 6o"ate'❑"a"aaacNotansSm s
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS