HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEi INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -O
Date: l'1 Permit Number. I
us yo g Al
Building Permit Application
Planning and Development Senkes
Building and Code Regulation Division -
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 -CofY mercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address- ea i' F
win or
Legal Description: C S j
c j L i - 6)
Prope Tax ID#: ` - Lot No. f-6 _
Site Plan Name: 5_6 L �(I Block No. (,2S —
Project Name:
s
Setbacks Front Back: Right-Side:, Left Side:
DETAILED DESCRIPTION OF WORK:
a
CONSTRUCTION INFORMATION:
Additional w rformed under this permit—check all apply:
.4
HVAC Gas Tank ❑Gas Piping _Shutters ElW indows/Doors
13 Electric 0 Plumbing Sprinklers 1:1 Generator Roof
Total Sq.Ft of Construction: Q0 S . , r .Ft.of First Floor.
Cost of Construction:$ U
Utilities: Sewer[]Septic Building Her ►Yl
OWNERAFSSEE: CONTRACTOR:
`^C C
Name Wcxcxf�rZ n_'t UC�0 ` c�tr A� (' Name: c:
Address: �Q I l/� �,���P Re d Company: r k
City: — (- Mate: Address: C 03 q /.
Zip Code: 3L •Fax• 41118 City: F f !cw� Statrre��:�L
Phone No. — U 'S Zip Code:, (!6>- - Fax: 2
E-Mail: Phone No.
FIN in fee sbnple Tide Halder on next page(if dWerent E-Mail:
from the Owner Mad above) State or Cou ' nse:
ff vak#e of coraumcdon Is$2500 or morn,a RECORDED Notke of Is required.
DESIGNER/ENGINEER: —Not ApplicableMORTGAGE 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: 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 room!�and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in youraaying 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, consu with lender or an attorney before
commemng work or recording our Notice of Commencement.
tgnature of Ow e-r/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORI <
COUNTY OF COUNTY OF
y
The forgoing instru,y�e�ntwas acknowledged before me The forgoing instrum t was acknowledged before me
this day of �.1� 20 ftf by this // day of 20_4 by
CA v
(Name of pYerson acknowledging) (Name of person acknowledging)
(Signature of Notar7011
State f Florida) (Signature of Notary Public-Mate of Flo ' a)
Personally Known Produced Identification Personally Known L/"'
OR Produced Identification
Type of Identification Produ pe of Identification Produced
•Ot...,,
.., DAWN mltume
DAWN MILONE '2' = COMMISSION#GG 04 8
MMISSION#GG 049998 EXPIRES:March 22,202'
2,202
Commission No. =*c •= oga mmission No. 'N al
:o
RES:March 22,2021 Bonded Thru Notary Public Unde ters
-;Fo1F M. Bonded Thru Notary Public Underwrite
Revised 07/15/2014 -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS