HomeMy WebLinkAboutBuilding Permit Application a e
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ti4t Permit Number:
ITS
-®-'----
EIVED
Building Permit ApplicatiEE1
Planning and Development Services 2019
Building and Code Regulation Division County,
2300 Virginia Avenue, Fort Pierce FL 34982 tY, Permi 9
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 1IVIPROVEMENT LOCATION r,: :.:,` .<..
Address:--� L N L(1C
Legal Description: Kn4 mo n M R.z�c)AS
Property Tax ID#: 01 y.Of,_501-0207 -OW Lot No.�_
Site Plan Name: Block No. IV
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA-1 LE_ D",
DESCRIPTION'OF 1NORK
`�,Y XYI @ GfU 1 f-COG rCS� nG S:z_e G )�e. I VA,
0
CONSTRUCTION INFORM
.
A----TION-
Additionalwork to be erformed under this permit-check all appy:
❑HVAC Gas Tank Gas Piping M
Shutters Windows/Doors
11 Electric Plumbing Sprinklers Generator F1 Roof
Total Sq. Ft of Construction: !! SFt.of First Floor:
Cost of Construction:$ / l�o .37 Utilities-n Sewer[]Septic Building Height:
Ow. E.
LVTRACTO R ,
Name Name:
Address: WO l 0 i u �' �{ C Ge.`t' Com an
City: i t Q�e c�2, State: Address: i,��1 in I -75A11 C'-C R
Zip Code:3LfggD Fax: City: d \ (dl ie'c C,_1, Stater`__
Phone No. -)"7a -g?O `Li G 07 Zip Code:3�Ll l '-4-- Fax: D-[;,I qV
E-Mail: Phone No. C'S =:z
Fill in fee simple Title Holder on next page (if different E-Mail: ,�;
from the Owner listed above) State or County License: l_ (�? l C11 1,4 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r
SUPPLEMENTAL`CONSTRUCTION LLEN LAIN INFORMATION h
'
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 thepermit 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
coryfijhencing work or recording our Notice of Commencement.
lmp1 S
ignature f wner/Lessee/Agent nature of Contractor/License Holder
STATE OF FLORIDA Lux
STATE OF FLORI A /
COUNTY OF �t`, l—l��U COUNTY OF �(a l� ('h
The foroing instrument was acknowledged before me The forgoing instrument was acknowledge efore me
this�day of FYI` 20 ] by this day of /— l 20 ?by
—f
0 n ��atpne x 7 001 IA'5
(Name of person acknowledling) (Name of person acknowledging)
— J1 _, I ? I J2�z-_-� _��D
(Si ature of Notary P lic-State of Florida) / (Signatur f Notaryblit-St of Florida)
Personally Known OR Produced dentification ✓ Personally Known —,--'OR
/OR Produced Identification
Type of Identification Produced F4- VrIV•Zr UP dLs:!r:� Type of Identification Produced
Shellie Ann Leeder otPRY P�eAN@ELAYOUNG
Commission No. c ' oma A&"Y PUBLIC Commission No.
ASr udssloN#FF 9s1069
o
STATE OF FLORIDA
_N9 .cX EXPIRES:April 12,2020
=m G256069
Revised 07/1S/2014 ,INCE Isw Expires 9/29/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS