HomeMy WebLinkAboutAcpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date:.f1 I Permit Number:
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o
Building Permit Application
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
PERMITTYPE: Pt
PROPOSED INPROVEM'ENT LOCATION.
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Address: 4ti E" 8os
Property Tax ID #: � -� i ( — - 1'6';1 - 6 o - Lot No.
Site Plan Name: ' �� lr l 1Ji1V�%}` �{ Ii� (<� G '� [ i Ci 1�[ �M r ici Block Na.
Project Name:
C�ETAILED DESCRIAT�C}�"OF 1NORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank Gas Piping — Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ z�3. cro Utilities: -Sewer —Septic Building Height:
OINNERfLESSEE:
CONTRACTOR:
Name ".S "a ' .�Ly 1.
Name: t l
Q
Address: I �r i - it
Company �i_
City: State:
Address: 'SO t ov
City: -L-6State:
Zip Code: 9 4J 9 Fax:
Phone No.
Zip Code, i_ C Fax:
E-Mail:
Phone No-74q% "_ _' �2A _
Fill in fee simple Title Holder on next page ( if different
E-Mail �'m � c! .� i't�i ickn C ( l't� , ' .�
from the Owner listed above)
State or County cense 54
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
8
OESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State'
Zip: Phone:
FEE SIMPLE TITTLE BOLDER: � Not Applicable
Name:
Address:
City: _
Zip: Phone:
MORTGAGE COMPANY- � Not Applicable
Name -
Address;
City: State:
Zip: Phone:
SODDING COMPANY: .,Not Applicable
Name:
Address:
City:
Zip: Phone;
1 certify that no work or Installation has commenced prior to the issuance of a permit.
St. Lucie County make no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con ictwit�h any applicable Nome Owners Association rules, bylaws or andcovenantsthat 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 (if the granting of this requested permit, 1 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 fallowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary 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 Jh,qfirst Ins ection. if you intend to obtain financing, consu n attorney before
corm_enci rcor recor�ur Notice of Cornmenceme�
�"Sigriature:of:Uwnerl Lessee/Agent r�u.
STATE OF FLORIDA �
COUNTY OF
The fo�� �.� ping Instru ent was acknowledged before n
this May of t4 zb uby M mg
cJ t `la ` 15
��p15YF 111���
(Na►nepf person acknowledA-ing) „ y
re of Noi:ary Public- Stag
Personally Known �OR Produced identification
Type of Identification Produced
Commission No.F___ `::9 1 (Seal)
Revised 07/15/2014
gnature
STATE OF FLOW
COUNTY OF
V_
The forgoing instrument w s acknowledged before m
this `day of Y� 20 I'l by
.s a
(Name of Orson acknowledging
of iNbtary Public- State of Florida )
Personally Known 4.:�011 Produced identification
Type of Identification Produced
Commission No. E1 $'- c I (seal)
REVIEWS
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SUPERVISOR
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VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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REVII W
DATE
COMPLETE
INITIALS