HomeMy WebLinkAboutBuilding Permit Application (2) 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Ica ° ®Jrm
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 I Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
42 4..r
�. � Y -_ Y
n. t
Address:_')-a-M-g_lnQ'C1S+6()C. �r �u-z �'ocf SQ►n�Crr,P
Legal Description: f V1Ct.t.c',l 6me_, PC> q3-1 1
I
' I
Property Tax ID#: 33;L),-50S -oo-)X-Qdo`'5 Lot No. Gq
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side�
t 5��'` id'. �`. ,,�-a"�✓�+�t $ '' �c.��i�`�'ay=tig::�'� < -:�. ,.r c�����' �i*-''xt �ts.c��.. i,F�' :"" �3`�r �c�> -�._�._ :k• � -.�:
E�RIPTIUYV � �1NOK Y x Peif
'�,�`i:w_. � 1.4",
:..�,spY,
I'
i
i
S"%➢awX` .'`.. `4: _.r� i-, iia:;:' ` EL14'a a«. -
y. F..``M "i` %�`i �?'�' '� �"ki'�`�,:4#
Additional work to be ertormed un er t is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _ShuttersWindows/Doors
Electric ❑_Plumbing Sprinklers Generator ❑_Roof
Total Sq. Ft of Construction: S . Ft.of First Floor::
Cost of Construction:$ [3'a 'q g Utilities: Sewer ElS ptic Building Height:
l `ER LEAM
SSf,; T C ° .
Name_( 7LuC,kCtC_ A n+'�C Name:
Address: rnQ,idStdR__ Company:T.1-(
City:P6 C+ 5 Q n f (A,60-- State:EL Address: i,;'2,a (e'l -7c•LTf1
Zip Code:3 L4q SSG Fax: City: L-0, �ffilvw e'-t C-1-_ State:-F
Phone No. -7 3 a- au(-QQ 30 Zip Code:7"sL) (i a--- ' Fax. 5L°I 5 Clb5
E-Mail: Phone No. 5b,
Fill in fee simple Title Holder on next page(if-different E-Mail:
from the Owner listed above) State or County License: to C-
I;
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANYI' Not Applicable+
Name: Name:
Address: Address:
City: State: City: i State:
Zip: Phone: Zip: Phone:;.
I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: I
IZip: Phone: Zip: Phone: i
I �
1
I
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 Commencement. i
6�— < _ s
_Signature of Owner/Lessee/Agent ygnafure o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI AI
COUNTY OF ./j COUNTY OF 4&Ivy)i5ep,c�1
I
jThe forgoing instrument was acknowledged b fore me The forgoing instrumen was acknowledged fore me
i this_L1%y of l 20 _by this day of 20 by
_Denf0-a �` r �� jj�
1 �E'� y LJ Il�,
(Name of person acknowledging) (Name of person acknowiedgirg)
,(Signature of Ni Pu li/c-State of Florida) (Signator of Notary P�ubliic'- tate of Florida}
Personally Kno 11 OR Produced Identification Personally Known l% OR;Praduced Identification
Type of Identification Produced Type of identification Produced
_ I
Commission No.s ?Z11--�6 (Seal) Commission No. ttRvauBtr� ( aL}YauNe
* Ml COMMISSION#FF 951069
£' 61>,2 A. N EXPIRES:April 12.2020
lFpF'FJQ4 Bonded ThruSudpetNotary Serdws
' Revised 07/15/2014
ComasiWw Exphu 711112921
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I
I '