HomeMy WebLinkAboutBuilding permit application ALL APPLICABLE INFO MUST B MPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numb I ' o'3
Buildi �"01 A licati
R pp o
Planning and Development Services . �
Building and Code Regulation Division ,PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County,FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from-dropbox, click arrow at the end of line
PROPOSED IMPROVEM:E'NT�LOCATION
Address: 1500 1 ��= i�inll rAkA__ D110Cf pnr+ l.w_ltP EL- 3�QSZ-
Legal Description: c5 { LUC`,{P; �i C�I�n� C)13T ��L' LA( J_
Property Tax ID#:, o Lot No.3 ftti'b 14
Site Plan Name: Block No.
Project Name:'?,FSer- L 1 D oy-- Si-. L�Ao t P
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION-OF-WORK:
CONSTRUCTION INFORW IO'N.
Additional work to be nertormed under this h permit— 'check a apply:
EIHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: �® Utilities:cnSewer Septic Building Height:
OWNER/LESSEE, i NTT,RACTO:R
Nam 'T\ _D �^y RprAL f^S LX D, Name:1_,V-)'n lc L L�Pr w(-er)(C-
Address: - - C- -�Qr4_ Company: —
City: N C� Stater Address:
ZipCode:,3'0_ 05 Fax: City: 9-uCk.(- State:F�
Phone No.JaD-37�5� '5 00,0 Zip Coder q q �7 Fax:
E-Mail:M �t-eS"L2, ,,r 2-IUe1P,.Co-*, Phone No
Fill in fee simple Title Bolder on next page(if different E-Mail:-Pe/`✓`, Ifs ,CA qn IeLS C(o'''l
from the Owner listed above) State or County License:
If value of construction is$250o or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTR. .TIO.N,LIEN::LAVI 1N;FORMATION: ::.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE CO P NY: t Applicable
Name. Name: Aft
Address: Address:
City: State: City: state.
Zip: Phone: Zip: Phone.
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _-NNo6pplicable
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 ming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING 0' R.
Your failure to Record a Notice of Commencement may result in your paying twice for
improve ents to our property.A Notice of Commencement must be recorded and posted on the jobsite
before e first ' spection. If you intend to obtain financing, consult with lender or an attorney before
com encin rk or recording our Notice of Commencement.
114 4�� � h2�
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mature iv r ssee/Contractor as Agent for Owner Signatufe of Contr or/License Holder
STATE OF F R STATE OF FLORIDA
COUNTY COUNTY OF
The forooin nstrument was acknowledged before me The for mg instrument was acknowledged before me
this ay of 20 1�by this May of vA 20 P- by
(Name of person ackn led i g) d (Name of person acknowledging)
(Signature of Notary ub -State f Florida ) (Signature of Notary P b c- to of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produc Type of Identification Produced
MONICA GON
-Commission N �slssloN 44 —- Cam—mission No. 0 (Seal)
Jmue+y24,2017 tPy CouMW Samsel
�i NOTARY PUBLIC
I` Wv1*C1-a117`:
STATE OF FLORIRevised 07/15/2014 Comte 00049730
Expires 11122/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1 I
COMPLETE
INITIALS
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