HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ BlZlvf lit
Permit Number:
u I
Planning and Development Services Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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: 1CIO 2 y-iplpjl� a gver�ve
Legal Description: La k'LziacA_c,Y IL _ 11 r\ i �� _ P, LV� 41e I CST H <, A p 1-3/ 1 %
(0 52,-1ArA N
Property Tax ID #:
Site Plan Name: Lot No.�
Project Name: Block No,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
We Nil) supply and lnstau neN A0 gallon tall, electric Nater
htalrer, tocat-cd in rnf c�arac�e. J
CONSTRUCTION
Chia pernut—cnecK all app"
HVAC Tank ❑Gas Piping Shutters
11 Q Windows/Doors
Electric LJ Plumbing Sprinklers Generator
Roof
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ _I , U�1 . QO Utilities Ifewer Septic Building Height:
NameyiC6f Mediate
Address:_]90? Hol()pavv Avenue
City: FCW t P i e re e State: F�
Zip Code: ,;34cl 5 1 Fax:_N I A
Phone No. -f1 2- Ci-11
E-Mail:_N i N
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
construction is
Name: P
Company:50Jrh eyyl PlY it C lv r
Address: -�JOlcS 43``' Ave nU e
City: Ve V-0 g e a (' 1) State: F L-
ZipCode: 3Z(a0 Fax:]72-CI1g-g846
Phone No.
E-Mail:
State or County License: R f=pp V, 1 tp �—
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:
Name:
Address:
City:
ZIP: Phone:
_ Not Applicable
BONDING COMPANY:
Name: _
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
St,
Is inneonilict with anrepresentation
applicable' Home Owners Assoting ciation) ru esabylaws or anScovenants that maydrestrictbor prof 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
improve is to your property. A Notice of Commencement mu be recorded and posted on the jobsite
before first inspection. If you intend to obtain financing, co with lender or an attorney before
conrn ne work or recording vnur Nntirp of rr mm.n. +
STATE OF FLORIDA
COUNTYOF
The forgoing instrument was acknowledged before me
this"dayof /3UctiSt 201_�Lby
ng
Public -
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this 21k day of , U S t 20 k by
(Name of
ersonallyKnown OR P4)c1,tse4%11depEtf�iyaCwiostate of nor, aPer�ona�jKnown
Type of Identification Produced S JF Kristin Kylie Webb TV rfe of idantifirnt
Revised 07/15/2014
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FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
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INITIALS