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HomeMy WebLinkAboutBuilding Permit Application J , ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r _ Date: �� (�` Permit Number: ii I��l/OW Building Permit Application pQ� SFa®6, ° Planning and Development Services S�ierlo 1®,� Building and Code Regulation.Division 441,V oQ� 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 s a e s r. r t- � t�.s t'.t � s� �.„ 3 b,i r '�,•k x� st�w�� �� ��a'�" PR®POSEb1( . P�R01/EI�fEN�LOCATIC�Ny r t F Address: 9410 OCerm Jrt,y e. on Z+ 31S ` Legal Description:jnC.CE'n I©(ocr'S Jnrxgotor'r- c /lif;'* PropertyTaxlD#: 353:5 -176( Lot No. Site Plan Name:a� S4-�, S 2A ka Block No. Project Name: Setbacks Front Back: Right Side: Left Side: xl�a " i is p:E tAILDESCR{P cI? T{ONtita OFWORK r f ,t x `I R _�.,,L/ C�JC-OV daa C t)FA 3-4'C.' �e� i ,t'• .1v ,CS„Ifc'::s..a7,,.ca._.i�r Ja.at r„e.. ..... - .,-.-��.-_. .�., ._ .$'lU� _;. . :x; .. .: t .r; - ,n J„ �'�7t_,�'��:��=°c � ...E e: r� *f nn Additionalworkto (epe orme un er t ,s permit-check a appy: E1HVAC LJ Gas Tank ❑Gas Piping _Shutters IzWindows/99_0� Electric ❑ Plumbing Sprinklers 1:1 Generator Roof Total Sq. Ft of Construction: / SFt.of First Floor: Cost of Construction:$ �� `7 �� / Utilities: Sewer E]Septic Building Height: f?�,f i _i,] ' 7. �- t t "3,i s .,+ f alS✓q� ,g��(✓"s,.^.in iCONTRACTOR ' NameName: te> 1��►�c:�.."�� M :iU�i �TCe Address: 1 gra 3 a Sw JSLO a, S`¢'r cA-t- Company:yS-4- _� OC City: r- , CiM'L State:T-1 Address: i,_�`-I Cn j -7!i_-H C11- A. Zip Code: 33 l_7 S Fax:CEJ City: State:_E�_- Phone No.3 OS- Q7 -11 Li Co ei Zip Code:�� E-Mail: &r^¢sl�- vo4_0 R-4. jQ4- Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: (2 63 C, C) ��c�-�i5 3(• i If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 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 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 f ' to Record a Notice of Commencement may result in your paying twice for improvements to your prop y.A otice of Commencement must be recorded and posted on the jobsite before the first inspection. If you int nd to obtain financing, consult with lender or an attorney before commencing worJeo—rrecQFc0ng VouVNotice of Commencement. e ti s _Signature of Owne gerl.t__� Si atu Contractor/License Holder STATE OF FLORIDA STATE OF FLOR A COUNTY OF Dc. Ao COUNTY OF T a It,Y The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this a day of lav ,s. — 20 �l!!by this day of (10 _ X 20 by ---� KCFSK'TG.Y+Gk e• LG (Name of person acknowledging) (Name of person acknowledging (Signature of No blit-State of Florida} (Signature Notary P ic-State o orida) Personally Known OR Produced Identification Personally Known _ Produced Identification Type of Identification Produced Type of Identification Produced Ry PU Commission No. « CMSIU50ARES5ANTANA Commission No. =°`R e` ��}U�� 11 , ea; .(✓ .4 My UUNI ISSlull#FF 951089 �°• diary Public-State of Florida �" Commission 0 GG 284394 w z"'� v EY,PIRES:April 12,2V210 Nty Comm.Expires Dec 13.2022 ''`�' roug anon Notary Assn. OF P1. - WOW 1nru®udgotNotary SoMM Revised 07/15/2014 REVIEWSFRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS