HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(r
Date: Z l� —}1� Permit Number: ri O
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Building Permit Application �
Planning and Development 5erv4ces [SEC 1 3 'L it
Building and Code Regulation Division PE=I fl 1 I;'
2300 Virginia Avenue,Fort Pierce FL 34982 St. L:,-i,
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residentiaf
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5L ((}� (aIYIY� JP1� 14k. , p,��L� L
Legal Description: `1 ?j�) E2)_q11Z 0� l�lW `UU of Vit; 114 -Lr_!)5
11(1 5sIIS LU�:��I���O(L Un2�•- L(L/l 7)
Property Tax ID#:ZOO< - 1_�z" 0000 —0�U'(� Lot No.
Site Plan Name: Block No.
Project Name:
y
Setbacks Front Back: Right.Side:' Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performedunder tispermit—check all appy:
HVAC 01 Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric F Plumbing Sprinklers F Generator Roof
cI H
Total Sq.Ft of Construction: 0 S C1 S . Ft.of First Floor:
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Cost of Construction:$ (L"y Utilities. Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1 'M � Name: tj C
Address:r)2- TVA* Company:
City: ,date: Address: z c 3 C rk P m tc__
Zi Code: >LA G� Fax:
P City: F f V1 C•l'r� State:�t—
Phone No. '91 Z' ` Zip Code:3 �(�� Fax: 7 - 66f
E-Mail `v I Phone No.
Fill in fee simple Tide Holder on next page(if different E-Mail: cz ecyr d
from the Owner listed above) State or Coun icense:
ff value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
MD=ESlGiNERj/EfNG'lNNEER:-. Not ApplicableMORTGAGE COMPANY: Not Applicable
• Name:
Address: Address:
City: State:T City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: * _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: y Address.
Zip: Phone: Tip: 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=older to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and Mvenants 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 1 will,in all respects,perform the work
in accordance with the approved pians,the Florida Building Codes and St.Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screewroomVand accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resuk in your•oaying twice for
Improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before oe first inspection,If you intend to obtain financing,con with lender or an attorney befiore
corn a 'n work or recordingour Notice of Commencement.
Signature of Owner/Agent/Lessee siigr►ature of Contract6rTLIcarse Holder
STATE OF FLORIDA STATE OF FLOR16A
COUNTY OF L I c,Lr" COUNTY OF
Theinsbu enc was aclonowledgedbefore me The instrument was admoMrled®ed before me
#&_a da of 4
� - -20 by this da of.�1 C, '20 by
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(Narne of Person ) ng)
ftetwe of Notary Publk-State of Florida) (Sig wWe of Notary -State of Florida)
Personally Known ORP Wagon V Personally Known OR Prodywd IdentificationType of Identilkatbn Produced t, l-,, Type of Wentification Produced F- 1.
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Commission KA R N I E L S E N Commission No.
Comm, s,or 8 FF 115637 Co Ami NIfL$�N
My Commission-i4pires ss'on# FF 115637
;° My commissi
une 1
Revised 07115/2014 2, 201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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