HomeMy WebLinkAboutBUILDING APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
Building Permit Applicati®n
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 arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: OI SI
Legal Description: G,i OCQs-WAr
I�aas� I�r�1 �-ynl 1 D-19 3 joy Ade ai3)
Property Tax ID #: DID- Lot No._4 31
Site Plan Name: �S(X'�j,S ����
�,,� 1� Block No.
Project Name: _ �j(o(o I ,T bYIbS Vl �} IY(�V{ • �O�i Q
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
a--I�� U `' �" �" 1 v I O� 1 1 q� �(�(I VC '� �1.. p o I N o C.E..
if
`
(Ca) 5' wick-c WML — l S
CONSTRUCTION INFORMATION:
ACIditiona
work to e er orme un er tnis permit - c ec a tat a
0 t o p p Y:
1=JHVAC _Gas Tank 0Gas Piping OShutters Windows/Doors
Electric ❑ Plumbing Sprinklers Li Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ u ' Utilities: Sewer Septic Building Height:
OWKNER//LE��SSE�CONTRACTOR:
Ir�E:
Name—, 7, a JrrA 1 1r) Name: DA Iclhad
Address:n� �S nj '�jV2� Company:�no(�tL1r�� L- ^��r_CfinT T-A
City: p� py p State:_�L Address: 10$ &x
Zip Code: 3 4CCs Fax: City:[
c�p__— Stater
Phone No._ 0D Zip Code:Fax:
E-Mail: i Phone No. �`� 1 510(' q O$
Fill in fee simple Title Voider on next page j if different E-Mail: ly) Q I�Awy-wion Lel
Jrom the Owner listed above) State or County License: C6 1511C
If value Of cOnStruCtiOn IS 52500 car mnra a a�rnoncn n �: _c �___.__ _ _
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
Name:
� Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
MANGROVE
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
DATE
Address:
City:
City:
Zip: Phone:
)MPLETE
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 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
improvemen to your property. A Notice of Commencement must recorded and posted on the jobsite
before the ' st inspection. If you intend to obtain financing, cons with lender or an attorney before
commen ' work or recording our Notice of Commencement.
c
ignater/ Lessee/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF g} , l�C j� COUNTY OF S{ .LL le
The forgoing instrument was acknowledged before me
this �hday of M1rl P 20 12 -by
(Name of perlon ackn
of NptalrtPubT Strife of Florida )
Personally Known �� OR]
Type of Identification Produced
Commission No.
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this_day of �Ucl� 20 I by
ffliclI'nkl . Uhlck o
(Name of person acknowledging ) 11
Public- State of Florida )
Hy Known OR Produ
KRISTY SEXTONType Identification Produced
Notary Public - State f Florida
` Commission # GG 2)V44 Sion No c
' My Comm. Expires Apr 1 }.41
Bonded through National N ary Assn.
Notary Public • State of
Commission N GG 201
My Comm. Expires Apr 1
Bonded through National Nota
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
)MPLETE
INITIALS