HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /,,
Date: Permit Number: Jr710 d(&QQ
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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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: =72,96 M6g/,6)Z4ic1,1 444f- b9f 5T Lucxc rb �;c96a
Legal Description: to PIZF3CPUz—AT SYavgl719/3 26L/.6 _ A_1`W Gal V/. fix 1,3n-S 3�
'Property Tax ID#: MD5- 706- 6ILL 00c-2 Lot No. at,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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orme un er t ispermit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric E]Plumbing ❑Sprinklers E]Generator Roof 3l�- Roof pitch
Total Sq. Ft of Construction: QO Sq. Ft.of First Floor:
Cost of Construction:$ 9 b qd Utilities:11 Sewer ESeptic Building Height:
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Name LULLL-r/ �I��JT��- Name: �',3d S• �106,9-i1/
Address: qVX, /.JPCiJoZJ1!-41,1 Company:t1_9EQT/rJ,gJ_- p F11) N6
City: ///I' S! LI,Pc�� State:L Address: /60/ Sc—_ S: OrLBLyQl Li�IZC/C
Zip Code: :-3 Y9,6? Fax: City: :Rbnf SF State: FL
Phone No. Zip Code: Fax: -17a- 33.E 95'53
E-Mail: Phone No. `77a-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County,License: 000 3c Sl3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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St1p PLEN1'ENT LCC}i K,RU .Ci N L�tN N R &,
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 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 recor ing your Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/L' se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF --IFLUCTc COUNTY OF 61 L UC:k
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ` Aday of 0CT1;16&_& 20 J7-by this 2Olday of DCVA/ git _____120 11 by
I0_1-a,gyV I-14MaL RIM) S• /i96 9W
(Name of person acknowledging) (Name of person acknowledging)
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(Signa re of NotaryP blic-St a of Florida) (Signatu a of Notary Publi -State o f lorida)
Personally Known OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Produced It A-1534,93a--Sl-01-7-0 Type of Identification Produced
Commission No. GG-09,737rau4, (SeapENISELEMAY Commission No. �rGD'Z7 . 6 (Seal)
* ��' *MY COMMISSION#GG 077376ot►R.°,oe,� DENISE LEW
1 2MY COMMISSION#GG 077376
9�00F P`o"� Bonded TTu11 BudgetNomry SWCM `oma EXPIRES:March 23,2021
Revised 07/15/2014 rPOP tva` ThN Bud*Noma SwAm
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CO M P LETE
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