HomeMy WebLinkAboutBuilding Permit Application > ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: )''/ • ) _9 Permit
4 -
Buiiding Permit Applicatio JUN 19 201
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 $t. Lucie C o u n ty r FL
Phone:(772)462-1553 Fax:(772)462-1578 . Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line e e,'
;PROPOSED 1MPROVEM`ENT LOCATION:
Address:
Legal Description: RQ_ cCX' tom?z-')6'P6
Property Tax ID#: o;W2,3-5d(-000LP -Dom- Lot No.�_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:
.,fit O�) y4C4�:Ft L4aL.1 _Q� c.Z�)U_a &4V y
CONSTRUCTION INFORMATION
Additional work toe e orme under this permit-c ec a appy:
HVAC 11 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
13 Electric 11 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: lo-2 Sic.Ft.of First Floor:
Cost of Construction:$e��/1� °O Utilities: Sewer[]Septic Building Height:
`QWNER/LESSEE: CONTRACTOR:`..
Namer_hrL-Ac�phzc—a-Carol.ic-e_ Mcrr-1-, Name: Nc k
Address: ILIoI 21s4 -s Company: r1a
City:Ror-4. State: F- Address: U5 �C-34
Zip Code: Fax: City: Fov-�• ?,ax P State:F-L_
Phone No.'77a-353- c94oE/,2 Zip Code: -'3qI?R'a Fax:
E-Mail: Phone No.-77P,-050 - y'10_7
Fill in fee simple Title Holder on next page(if different E-Mail: n f uo 1',t'..,
from the Owner listed above) State or County License: �p
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.Lucle County makes no representation that is granting a Permit will authorize the permit holder to build the subject structure
which is In conflict with aril pplicable Home Owners Association rules,bylaws r and covenants that may restrict or prohibit such
structure.Please consult wyit�i 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,wails,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.
IaJ —ali,
S
Sign ture of Owner/Lessee/Contractor as Agent for Owner Sigiiature of Contractor/License Ho
STATE OF FLORIDA STATE OF
COUNTY OF -L.c�c� COUNTY OF FLORIDA,-, Luc,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I? day of Q_Lt{1 20 LI—by this 1`7 day of 6c,10 .20 11 by
(Name of person ackno edging) (Name of person acknowl dging}
(Signature of Notary Publi�c- f Florida} (Signature of Notary Public-State of Florida}
Personally Known V" OR Produced Identification Personally Known O R Produced identification_
Type of Identification Produced Type of identification Produced
Commission No. C::P&aP9 OL47 (seal) Commission No. (Seal)
GABRIELLE HICKS
• MY COMMISSION#GG 069047 _ My COMMISSION#GG 069047
EXPIRES.February 2,2021
• o ' :� Pudic thx rtitew
Bonded YNotkLCteNei5z:fd ,4t.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS