HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date..'ObLa1kci Permit Number: o
Building Permit Application MAY 17 2r9 I
Planning and Development Services
Building and Code Regulation Division Permitting D e p a rti i"1 C n t
2300 Virginia Avenue,Fort Pierce FL 34982iti��
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R si Cie County, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the`end of line le r7n)&4 i
PROPOSED IMPROVEMENT LOCATION t
Address: '54A9 9L)
Legal Description:
Ave
Property Tax ID#: - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF.WORK:
9-eQN5C2 \4%.ae AUN 9:����a�,.ce� -� ��SQ oSLS, uCciA d.n
kil
rtSNa.\\ r�2�,a Cc�\6w\CASNSTRlJCT10N INFORMATION: vc ,dn. .
Additional work toe nertormed under this permit—c cKall appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
OW N ERAESSEE': CONTRACTOR:
Nam3 Name:
Address: iL�' Company: `�\ ,_ �\ k-J\(
City: State: Ad ss:
Zip Code: 01 Fax:a&— - L City: Stater
Phone No.ab�' —28A-nL�jA Zip Coder ���� Fax: -
E-Mail:tf « �l a�(►� Qf��.�(�cV\ Phone No.�
Fill in fee simple Title Holder on next page(if different E-Mail: "�(\
from the Owner listed above) State or County License: �5`����� (hGH
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI LIEN LAW INFORMATION: z
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: Lf`hot 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.
(� s
Signature of Owner/Lessee actor as Agent for Owner Signature of Contractor/License Ho
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'il L COUNTY OF S:917 The forgoing ffo'rg^oing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this�-N-day of 20�qby this 1�B day of a 20 l3 by
OCAA afj 6r6ylc R.I�lJ
(Name o n ac nowledging) (Name of per ac nowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public- t to of Florida)
Per ally Kno OR Pro Identification Per Wally Known OR Produced I ication
Typ entification Produ ��� 6a y T ication Produced ��� 2ND Ne
�
Commission No. •SP�B' , t°m�5�°�°be� p)a0 Commission No. °:*�& ••,,�°Mm �jEam��eu
io:E�4��e6mN�`0
IVA
Revised 07/15/2 ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS