HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
RECEIVED
Building Permit Application OCT 18 201119
Planning and Development Services
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
Nddress- q% 30
inrN:s Wr,_4 - - -
Legal Description: s 04:z Q.
Property Tax ID#:M W-50 t-<)Q77 5? Lot No. Gq
Site Plan Name: Block No. ..19-
Project Name:
Ems !ex-AzO
Setbacks Front Back: Right Side: Left Side:
M
7-M
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rtionaVworktobanartormed underthis permit-cnecK all that apply:
E Tank- ElGas-Poping F71-,-;hfjtters nclows/Doors
HVAC 2-Wi
FIE-lectric ■ Plumbing nprinklers 11 Generator E]Roof
Total Sq.Ft of Construction: SCI.Ft.of First Floor:
D Sewer U Septic Building Height:
Cost of Construction:$ I a Utilities:
Nam -0-r QA Name: .'
Adclress:':�,IOL Str-Ca�t Company.'ZF�4,co Qc)L C-Q,
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City: ,6Q Ll� State:&Pj)� Address:
Zip Code: 0LC9 c9�O Fax: State-_F_L—
Phone No. aLL6 -Liq I --a 0 (1 Zip Code:3!Ll I Fax:-5-L.,I !B755--elo 57Y I
P h o n e N o. 5-b
E-Mail: ri*iPnaP24@hntmaJ I -com
Fill in fee simple Title Holder on next page(if different
E-Mail:
from the Owner listed above) State or County License:
If value of construction is$Z500 or more,a RECORDED Notice of Commencement Is reqyired.
rDESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
DENER/MENGIN
SIG
ar
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Zip: Phone: Zip: Phone:
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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 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,ncing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
pa< �c1-v s
. Signature of Owner/Lessee/Age-ft ('IVaif6re of Contractor/License Holder
STATE OF4*0ftfft 140v q t ana•
COUNTY 0 fqi4p-o STATE OF FLORIDA
COUNTY OF_ P0,11ty-J
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The forgoing instru t acknowledged before me The forgoing instrument was acknowledged)?efore me
this 11�':clay of 20 LI-q-1by this
_;Mwas day of ,20 aby
Pie)
knowledgiin '�J
TName of person acknowledging
a {Signature Notary Public-State o lorida 1
"A
KA _V�6�\ R Produced Identification LZOR Produced Identification
Reson Personally Known
'Type of Identification Prod ced Id D I _L De of 'fication Produced
Identi
MA P
It & BISMARCK F.90LANoS
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Commission No. goal(Seablotary Public Cc mmission No.
GELROUNG
State of M4ryland
W COMMISSION 9 FF 951069
Qu
tAFIKM Apill 12.2020
Revised 07/1512014 pn My commission exp.October 19,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS