HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO M T BE C /PLETED FOR APPLICATION TO BE ACCEPTED
Date: i I Permit Number: r — �
Building Permit Application
Planning and Development Services
Building and Code Regulation Division I
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the e�d of line
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Address: ROW xoi)6� —DaxUE
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Legal Description: LTfW(_!S At 3 A'1201n.011 (t U,13 126 46--317) 3-SU6 Vii? COT (op- 019-504)
PropertyTax ID#: Mas_ 76-?_ D15'2- 0Do--9 Lot No.
Site Plan Name: Block No. 33
Project Name:
1
Setbacks Front Back: Right Side: Left Side: I
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Additional work toe nertormed under tis permit-check a appy:
HVAC Gas Tank Gas Piping Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator � Roof Roof pitch
Total Sq. Ft of Construction: 1300_ S . Ft.of First Floor:
Cost of Construction:$ 101 Utilities: Sewer OSeptic Building Height:
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Name Jbi llie L- plif-yTolsR Name: 014Rbir/1F9L-PACV?FTA6- K 57bV06-
Address:904 L006- b-k3 UI Company: P 1/'
City: -Tb12T ST f.acae State:fl- Address: AN 5E S• 6TL M0q&'ZC CT-iZcl"e
Zip Code: 34/q-5a Fax: /EJB City:11 tr 6V I_U elm State: FL
Phone No. Sb't- Oq6? Zip Code: ZV259- Fax:*I�Za,33 cf�5�y
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E-Mail: 'CIA Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: b,6*771ft
from the Owner listed above) State or County License: C�63aj 13
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: i _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: I Not Applicable
Name: Name: I
Address: Address:
City: City:
Zip: Phone: Zip: Phone: I
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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 our Notice of Commencemen
SigSig ure of Own r/Lessee/Contractor as Agent for Owner Signature of Contractor/Licen§kFJ61der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 61 LLI CZ744' COUNTY OF Sr Lu xr
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,JUtray of 6GTUY?)&_`1t 20 LI-by this 174h day of 20 L7L__by
(Name of person acknowledginpk.?&e�, DENISE (Name of person acknowledging
? ., o*MY COMMISSION#GG OT7376 otaRY PLe�, DENISE LEMAY
EXPIRES:March 23.2021 d I *ply CpN►M{SSION#GG 017376
�9 OFF�°Qo Bonded ThN Budget Notary Serv+cesJA Q EXPIRES:March 23.2021
(Signat Ao of Notary ublic-9tate of Florida) (Signature ot Notary Public-State a'f c d&tded.ThruBudgetNotarysw&es
Personally Known w/" OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
/� �tnC Wp� DENISE LE at►�:P!'ei, DENISE LEMAY
Cstr D`��37 e X111 COMMISSION#GG 0 7 �j� ()']' "A COMMISSION#GG 0773
Commission No. * commission No. I3 t
EXPIRES;March 23.202 I �, oQ EXPIRES:March 23,2021
P r N B Notary 9�`QOF VV13 Bonded Thru Budget
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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