HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application Nov 3 0 tots
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:2"?14 2 kfvc-Imo d
Legal Description: ' o(11 PQ;L A f,ee)d g± ?G A V���e�
Property Tax ID#:.33 a2" ?®'( -OQC2-2 -060 Lot No.,E
Site Plan Name: Block No.
Project Name'
Setbacks Front Back: Right Side: Left Side:
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Additional work o be ed under hispermit–check ail appy:
0HVAG Gas Tank []Gas Piping Shutters windows/Door
aElectric _0 Plumbing Sprinklers Generator 01 Roof
Total Sq.Ft of Construction; S .Ft.of First Floor:
--- --Cost of Construction:$- o[ .g (• 6 3 Utilities Sewer Septic Building Height:-
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Name l c c+e c� cd Name: , •uJC `'��`,�—�3s�sc_�a
Company:, C1r'Qf"% 6'u -+�i C.
Address: 1': f i T--b A--%
Zip Code: 's Fax City: i t�d,D�`lDr: ~ Stater(--
Phone No.C.9 Zip Code-.3z l I Fax: Lri t�'3✓S-�fU
E-Mail: Phone No. 5f.,i-
Fill In fee simple Title Holder on next page(if different E-Mail:
from the Owner listed.above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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a� aQ%vEi .n: _ti, +'S. ; •�if.�as f:�.nKe
.- •IDESIGNER/ENGINEER: Not A licable f
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: Cid,:
Zip: Phone: Zip: Phone:
I certify that no work or installation.has commenced prior to the issuance of a permit
St.Lucle Counttyy makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
which is in confEict with any applicable Home Owners Association rules,bylaws or ancovenants 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 thisreguested_permit<_I do hereby agree that i will,In all respects,perform the work
in accordance with the approved Plans,the Florida suiiding Cbde`s an�f 5tt Curie Couiriy 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.
Wt "/ s
_Signature of Owner/Lessee/Agent . n ure of Contractor/License Holder
STATE OF FLORID - STATE OF FLORI A
COUNTY OF_ � P ICOUNTY OF Wio P
The fo oing instm ent was cknowiedged before me The fo oing instrument was acknowledged before me
this��day of QQA r 20 ILby this "day of /��f S .20 by
1 ken
(Name of person acknowledging) (Name of person acknowledging)
d EX-
- -(Signature of Notary Public--State of Florida) /- (Sign atur of Nota =OR
of Florida.)_
Personally Known OR Produced Identification �./ Personally Knownduced Identification
Type of Identification ProducedR I IiVJ b kt['I(�Irl[, Type of identification Produced
Commission No.Chns &1-00 ee&Mftion No. (Seal)
7f.4WV
Notary Public State of lorida ocARY a✓B�^ ANGELAYOUNG
Vctor Hunter _
, eEr20 �
.EXPIRES:Aorii 12.2020
Revised 07/15/2014 FOFF10
0
I3ondedihru®udgotNotary Sorvices
-REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS