HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 Permit Number: TZ-0�13
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Building Permit Application s , �
Planning and Development Services
Building and Code Regulation Division Pc
2300 Virginia Avenue,Fort Pierce FL 34982 G���P4E
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential tz
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED'I',w`y'/wl1'PROVEMENT LOCATION
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Address: 5aO3DerC' (Lc)n _Dc'► V e, i
Legal Description: iAo l-'ric,�t P'rneS
Property Tax ID#: 13 (3-SOa-00Q 3"Q0O"d, Lot No.q N U
Site Plan Name: P u l ?e.n nett Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D;ETAILEnD�DESCR'If'T 'OF�WORK 3 '
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C.. ONMSTUCTOF.O - ATIO+.:•N .&
Additionalworkto e- e orme under tispermit-c e.!c:=t ia ,:•.:.. appy:
HVAC be
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Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft:of First Floor:
Cost of Construction:$ 3 c�U5. 25 Utilities:Sewer Septic Building Height:
0111%',1LESSEE ,CO�VTRA3CTOR' s �, 5 � `
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Name Vau L Qknr\e,-I`'Ii-
Addres_s:5&03 Occ-c 2c r-%-h ` Company:-M1_4--(,�
City: I"0 rf e-c'cr'a- State:� Address: i 9 4 U ( �1� Tt l (. -
Zip Code::?IM 5 ( Fax: City: i.0, 'r,� knry t'c (•r ,_ State:_)E_�---
Phone Noj—) -q7 I --i W a Zip Code:L5'�SLJ I Q�--- Fax: 5-4 1 4:/(,'5
E-Mail: Phone No. (:!T- S- S G! L,5 el
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: , c" ��c�-tSS 3)-
If
)-If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEM" N1`iAL'CQ�NSTRU -7 Ia 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: _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 thepermit 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.
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Signature of Owner/Lessee/Agent jkiiature of Contractor/License Halder
STATE OF FLOR – �s� .I STATE OF FLORJDA�� � ��
COUNTY OF �"`� �. COUNTY OF j/ I
The fo ng instrument s acknowledged efore me The fooing instrument was acknowledged before me
this_day of I� 20 LI—by this )rgday of /�Q f�' , 20 A by
l Jaltl-4e5 0-- (04`�
(Name of son acknowledging) (Name of person acknowledging)
(Signat N ary Public-State of Florida) (Signat a of Nota Public--St a of Florida)
Personally Known OR Produced Identification V/ Personally Known ✓ OR Produced Identification
Type of Identification Prod E(� el. A6jy M HUSSAIN Type of Identification Produced
* * MY COMMISSION 3 FF 942303 2ot!`..., ANGELA YOUNG
EMM)April 9,2020 SIGN#FF 951069
Commission No. Commission No. * * EXPIRES:
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J9rFOFF�oe�°!
Bonded Thru Budget Notary Sentes 9r oe XPIRE :April 12.2020
FOFF ? Bonded Thru Budget Notary Services
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS