HomeMy WebLinkAboutBuilding Permit Application VL-AVALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-� 1 Irl Permit Number: \A09-
RECEIVE®
Building Permit Application SEP I I zLls
Planning and Development Services
Building and Code Regulation Division ?T• huge County, Permitting
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 fl ba
�PRO,POSED�I(1'/�PROVEMEN t`LOCAT10t i t t �4` h , fi "W �
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Address:�5G'�b 0%
Legal Description: �tl
Property Tax ID#: A LLoa cc) -pctLi S Lot No. 1-1
Site Plan Name:�r �,��c [Jjp��p Block No. ��
Project Name:
Setbacks Front Back: Right Side: Left Side:
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�CONSTUCTCON�IFORMAgTlON
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Additional work to be performed under this permit—check all appy:
HVAC_ -[]Gas Gas Tank. ❑Gas Piping _Shutters 1� Windows/Doors
Electric 0 Plumbing Sprinklers a Generator E] Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$- �, -2 Ji dg Utilities:Sewer[]Septic Building Height:
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CONTRACTOR ti�� Y.
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Name_ t �"U f
Address: 9O C0393ZR .Ve. Company: ._f'4 (n C1CiA_rV '_" a-4 Q.
City: �� uP�fG� State: rJ Address: 1 —75-T+I
Zip Code:3LIC'R a Fax: City: i_0z'q` ;1yti c''C :Q I-,— State:_C--
Phone Zip Code:J*S`-I i Q-- Fax: :51A x075 ^C105
E-Mail: Phone No. 41
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: L 63 C,0
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DEStGNERJENGtNffR: 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 failure to Record a Notice of Commencement may result in your paying twice for
improver nts to prope A Notice of Commencement must be recorded and posted on the jobsite
tion. you in obtain financing, consult with lender or an attorney before
com encin work r rec din r- . tice of Commencement.
Lre of Own Lessee/Agent/_ Mature of Contractor/License Holder
STATE OF FLORIDA l STATE OF FLO D
COUNTY OF MAZT1K COUNTY OF A bea'r' )
The fo,,,,r�gP ing instrument was acknowledged before me The forgoing ie
nstru nt was acknowledged efore me
this 70day of AUW� 20 I�1 by this�day of 20 by
(Name of person acknowledging) (Name of person acknowledging
(Signature of Notary Public-State of Florida) (Signatu of Nota Public-S to of Florida)
Personally Know O Pr d ce i n 'fic-atiQn Personally Known OR Produced identification
Type of Identifica onr•d ce - -NIGItlS D.BRBWN-- AT Type of Identification Produced
,y SP a ANGELAYQUNG
r° 's Notary Public-State of Florida =o: �% f
Commission No. •- Commiss(1 WFF 900518 Commission No. m� * MY OC � ION FF 951069
My Comm.Expires Sep 1,2019 Nq °Q EXPIRES:April 12,2D20
f�� Sawndded Not"AssO.
1F E
Revised 07/IS/20I4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS