HomeMy WebLinkAboutBuilding Permit Application r
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /50
Date: `'� ' Permit Number:
E1W9D
Building Permit Applicatio APR
Planning and Development Services 2 0 2��8
Building and Code Regulation Division Pe rm itti n
g
2300 Virginia Avenue,Fort Pierce FL 34982 c e rtm e n t
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Re�idrhbi� i F(_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
m
Address: '70 N e_ IC.S 13 W d
Legal Description:_MC,-�kIc_S 1:'S1c,^A MOC' . J9 C.Or,QJ_6 SCl(4c6n /I
Property Tax ID#: 41. l 15(3 '000'q Lot No.
Site Plan Name: Block No.
Project Name:Ay n n-a C L_ r6 k,�_
Setbacks Front Back: Right Side: Left Side:
,.
=--
Chr)CS0-o f
itiona wor to e e orme un er t is permit—c ec a appy:
❑HVAC �Gas Tank Gas Pi in _
_ ❑ p g Shutters Windows/Drs_
❑Electric- um ng ❑Sprinklers ❑Generator ❑ Roof
Total Sq.Ft of Construction: So. Ft.of First Floor:
Cost of Construction:$ 3 0�3 d Utilities:Sewer❑Septic Building Height:
all
Name P►nri, Mewl R, i-0 klt Name:
Address:Q G 3 iJ<_�- l e S a lyi ef Company:—,14-Co Ock Q
City: SC_c,\SerN ctozg State:fI Address: 1 c} In —75 Is
Zip Code:3'19 $ 7 Fax: City:L,ta ` IWL__,k�PCj- C k, State:_F
Phone No. Zip Code:33y 1 a— Fax: 5-4,1 Cfy55
E-Mail: Phone No. 3b/- S-- !u C)
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C 63 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
"s
vl 4.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE 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: 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 Coun 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..lf you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
�\ 1
\L ( S
_
Signati of Owner/Lessee/Agent �ig�ure of Contractor/License Holder
STATE OF FLORID STATE OF FLORI A
COUNTY OF �� , b—ce l COUNTY OF J Q I ae=nL6
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledge before me
this�day of 0-r-w` 20 j%—by this�day of r 20 by
(Name of person acknowledging) (Name of person acknowledging)
lJl..
(Signature of Notary Public-State of Florida) (Signatur of Notary ��®R
te of Florida)
Personally Knowny OR Produced Identification Personally Known ProducedIdentification
Type of Identification Produced Type of Identification Produced
° ANGELAYOUNG
Commis s n err, 0 eal) Commission No. x _ gsLi
.`.Vai a A NELS N F.1Y C )0N 9 FF 951069
o EXPIRES'Apri112.2020
'r :°= Notary Public-State of Florida
Eonded Thru Budget Notary Sernces
Commission#Fir 965535
Revis •,, jMy Comm.Expires Feb 28,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS