HomeMy WebLinkAboutBuilding Permit ALL APPLICA�Nl NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: k Permit Number:AOL—
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F!34382
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click amm at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: U162 —Ro—fre. 3 4q 9�--'
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONS UCTION_INFORMATION:
rt na wor to (�ej orm under this permit-check a appy:
HVAC LJ Gas Tank ❑Gas Piping _Shutters Windows
a Doors11 ,
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction': S Ft.of First Floor:
Cost of Construction:$ S4y o' Utilities: Sewer FlSeptic Building Height:
OWINERAESSEE: CONTRACTOR:
Name Ewan Name: Q r'
Address: IPS ;L. Agcy& Mer l,�,l'(, Company: Yar, rimpj
City: lau'- State: R Addres : St0 A `i L T;eedecj
Zip Code: D A10— Fax: 01A- City: State: Ft,'
Phone i
43(o - %q Zip Code: .Vq51 Fax: IlkL11�ro'373E-Mail: k Phone No. _79• I- tat
Fill In fee simple Title Holder on next page(N different E-Mail: �Qv1PaC P� D0.UtO
from the Owner listed above) State or Co my License:_ COW IS(o
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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.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.
Signature of OwnekAgenk0ssee Signature of Contractor/License Holder
STATE OF FLORIDAi STATE OF FLORIDA
COUNTY OF A 1 Io u COUNTY OF 4
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this .d day of ELE S4 20 JA by e this ?o_Nay of .20_.W by �
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Vichad e t/7
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notaryblit-State of Florida) (Signature of Notary P ic-Staff of Florida)
OR12raduge 'A—
Personally Kno Personally o /
Type of IdentificPtIblType of Ide CRUM.pro U6eARISTINE J.C
= mutely � !µ a��'' Notary Public -State of Florida
i. •= Commis ion N GG 017839
Commission No. Comm. RA Aug 21,2020 Commission , mission* 6039
r'�Ofi°p``` Bondedthroug�Naunna�NolaryAssn. Bonded My Comm.Expires Aug 21,2020
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lhrou National Notar Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE -- --
INITIALS