HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 I1 Permit Number: ,1 �a 01 I
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Building Permit Applicati WhCEIVED
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Planning and Development Services 1 2��7
Building'and Code Regulation Division OCT 3
a 2300 Virginia Avenue,Fort Pierce FL 34982 a rtm ent
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ReoWhtlol9
PERMIT APPLICATION FOR: To Select from dropbox, click arrow a Ine
rl?i, PQSEDI PR®VEMfN;f
Address: o 2 n :rif ,n fie
Legal Description:
Property Tax ID#: _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:_
DE1A1 ED DE$CRIP�TI®N OF WORK
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CONSTRU,�C IONINFOR$MATIOIV
itio al work to be nertormed under this permit-check a appy:
HVAC Gas Tank. �Gas.Piping _Shutters Windows/Doors
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Electric 0 Plumbing Sprinklers - 11 Generator F- Roof' Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ .��b UtilitiesInSewer Septic Building'Height:
¢O�V1��NER E�SS,EE�: ��®NTRACTOR:
Namel (CIA IA J?,/ C� / .J ��! S� Name:
Address: /.0/ ? oc-&A.)-P R A v Company: l a ,
City: ���Sc� ���A State:�C, Address: Ae%ar1 A v`
Zip Code: S S Fax: City: L - State--cly
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Phone No. �.�4 ) �/ � Zip Code: ?L/ -7,c3 Fax:y
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: Ai �•� 6�J:C GilLj A a6.
I from the Owner listed above) State or County License: ! 2'n
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENI LAW II:NaF®R+NATION: Y
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: . `- Address:
City: r, =' State: City: State:
Zip. .. `Phoh—.e. ' .. ,;'.-. c Zip: Phone:
I '
FEE SIMPLE TITLE HOLDER_: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:"? r; 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 inspgction. If you intend to obtain financing, consult with lender or an attorney before
commencin work(fr recording our Notice of Commencement.
Z ///a/t::S7 s'
Sig 710nF
o caner/ a e/Co r t a gent for Owner Sig ur f Contracto icense Ho r ;
STA FLORIDA STATE OF FLORIDA Itic COUNTY OF T pt/G/L COUNTY OF �T � a✓
The forgoing instrument was acknowledged before me The forgoing instrume t was acknowledged before me
this day of AIJ6(j5 - 20 L7 this day of U ds��20 by ••
7W AAJA F-L- t&-J A 4
(Name of person acknowledging) (Name of perso cknowled '
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ro o
(Signat Florida) (Signature o Notary ublic-S of Florida) CD 65
Personall Known OR Produced Identification Personal —OR,Prod'Gced Iden
itificatioh
Type of Identification Produced Type of Ide t' -
y;:,_w '• °= MY .;t?liriln�:_,i1C o ?j
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Co sin ' Rf3SA 0C�9NZA� )
Commission � PIRFS Jul, (Seal) 1° o
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/A07139"153 FK9maNni service
JiPIRHS.iUl 01 2019 —
t�OJ)598-0155 Fb►dallota Sr�n9eu.cam .
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE %
"COMPLETE
INITIALS