HomeMy WebLinkAboutBuilding Permit Applicationr -
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,\
Date:. _ Permit Number: 6--) - oosi
Btll icling 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 ✓
PERMIT APPLICATION FOR: To :Select from dropbox, click arrovi sir the end of line
PROF 3SED IMPROVEMENT LOCATION: _
Address: JAUtl ky;Criotn a d Porgy S� Wt_1 _ iGL_3L4 j'? 4 - —
Legal Description: ply' sU-ro 1 ')Al -r L C Thr{ F rc h)
Property Tax ID #: -.?121 S� _ nf'�U' K Lot No._zi—_
Site Plan Name: q- 24-1- Block No.
Project Name: O v-l"hI p _
Setbacks Front Back: _ Right Side: Left Sid_ .
DETAILED DESCRIPTION OF WORK:
STRUCTION 1NFOR;MATION
t
CONTRACTOR
Name._ `7 /�'� "�
nalwork-to
,HVAC
Electric
e er ormeiF u3r
Gas Tank
0 Plumbing
t is permit- c ec
❑Gas Piping_
Sprinklers
a app
Shutters
Generator
Address:,50 g?A..1Nix.tLz, JLv 5-rc- LI -I
l� Windows/Doors
n Roof Root pitch
Total S 1. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �i. t:>7 Utilities:Sewer Septic Building Height:
OWNERAESSEE: T
CONTRACTOR
Name._ `7 /�'� "�
Name: (AY (-e
Address: j�..t 1 `} 1`t v ► �( _
, ri7
Company: rt►r r10 k Pco-4 trt
city: +_ K -r L1jci " State: -F1
Address:,50 g?A..1Nix.tLz, JLv 5-rc- LI -I
Zip Code Fax:
City: 5 1A _ r- r:_ Stater
Phone No. __j`i 'Z — 2.j! 5'
Zip Code: 31!L". Fax: 772-`1 - 2W5__
E -Mail: 4 J ft-
Phone No.7`1
Fill in tee simple Title Holder on next page ( if different
E-Mail:a(r j 6 e 0& amc , t , Copf
from the Owner listed above)
State or County License: C'A t S 1 -7 2 3C7
IT vawe or construction is $2500 or more, a RECORDED Notice of Commencement is re-iuired.
SUii�`� �
:T`S
.rs. ._, �
. 6
i`e`
�
IW�, n s
•d".
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
COUNTER
Name:
REVIEW
Address:
REVIEW
_
Address:
REVIEW
--
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:
INITIAI S
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 at exempt from undergoing a full concurrercv review: room additions,
accessory structures, swimming pools, fences-, walls, signs, screen rooms and accessory uses to another non-residential use
WARRING 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 vour Notice of Commencement.
as Agent
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Yk12 t ►n COUNTY OF (Y)AL+/ A?
The for oing instrument w s acknowledged b fore me The forgoing instrument was acknowledged before me
this J day of V'L 20 L by this day of (�i�U✓ cA,\ 20 LS_- by
1A, CAV- r e, r� A cl r �1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi tate of Florida )
(SI at ire of Notary Public- t e of Florida
Personally Known (i�R-Prci-diirerl-(8pqi,,*fic2t'nn Personally Known R Produced Identification
Type of Identificati n Pc*; Wcedd Type of Identification flroducpd
MY COMMISSION a FF235578dOROAN
Commission No. - ExPIRI li}�y 31, 2019 Commission No. ::'•". CHRISTI
MY COMMISSION # FF23557B
iJ.., ,L•r9 FMrMnNu;o'YSvrrF,u.:.un• r ' CYPIRFS July 31 2019_
� �. '�,� :,3 FkxMnNoa'rS�•raa um'
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGE"ATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
_
REVIEW
REVIEW
--
DATE
----
COMPLETE
INITIAI S