HomeMy WebLinkAboutBuilding Permit Application V I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Q.
Building Permit Application_ UP, V
Planning and Development Services1
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential I�
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
RROPOSED INEPROVEMENT LOCATION..r...,4Vu
Address: C�4"?
Legal Description: SG.n
PropertyTaxlD#:j�oZ�- nnba-�7((?� �Q(�d`c�+ Lot No.
Site Plan Name: K`�2Z`� 4, f[l�r�( e.�/ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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TAILEDDESCtIPTION OF WORK
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COI�STRUCTtON LN FORMATION t
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Additional work toffi
orme un ert ispermit—checka appy:
HVAC Gas Tank E]Gas Piping _Shutters Fv_�Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
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Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ t '855.4 d Utilities:In Sewer E]Septic Building Height:
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O;WNR�LESIE3 ri , 4 L 4 ,` r ,CONTRACTOJi" 4 �r� t ` '
Name K.2. e, r ri.VCA Name: Ucl' is e_c
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Address: `,(aL'? Me-uqs A &e- Company:. r
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City: ���' Pl�r�e� State: Address: t
Zip Coder LI,G L4 Co Fax: City: LL.. g:ga k Stater-
Phone NoQ7-1 -33-D- 0 0 3 Zip Code:-326L A 2�-- Fax: _n'l"95's--46:5-0
E-Mail:
95's-- 6:5-
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: G Co D zJR-3 I.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUP.�LE�V�t�N�A�`C-4fi15�RU"CTIQNL1'E-N L�11N INF�RII/IATIQN - Y z =� ��`���� _'���`
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
! Address: Address:
City: State: City: State:
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:
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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' 1
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.
I AA J A s
_Sig at o caner/Lessee/Agent ure o Contractor/License Halder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S ,j. vt ; COUNTY OF VAI6 e-42C h
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The for ng instru t was acknowledged before me The forgoing instrument was acknowledged before me
this�o ay of_�d:_v! 20��by this day of r°1��— 20 by
g �.S 0- On 0,:S
- (Name of person acknowledging) (Nme of person acknowledging)
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Ign'at of Notary Public-State of Florida) {Signatu of Notaryublic-Sta of Florida)
erson ly Known OR Pradu d�ldentification X Personally Known ----OR Produced Identification
Type o Identification Produced I— Iye/5 L,�P,s—C— Type of Identification Produced
��rr`rr+rr�+rr Commission No. =o2�RY pG��% ((SW SION#F G !
Commission N * MYGOMMI514NFF951069
EXPIRES:April 12.2020
�iQ�llft1188I0t1#t3627g764 i re a get Notary er ces
Fuph o December 18,2022
Revised 07No
7019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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