HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: : ,. � - ,%Z Permit Number: /7L121—On IS
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Building Permit Application 4 2097
Planning and Development Services JAN
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
PROPOSED IMPROVEMENT LOCATION:
Address 01% L. 3401
Legal Description: 0r'I
a= 7n-1-1934
1 Property Tax ID#: 1�3` �2� bl U3'- 66 - 2 Lot No.
Site Plan Name: Block No.
Project,Name: �'��Y) �e5r24ccni a.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
grove eyuQ'�Hng bh�ng� IrOo� on (Yla�n house-e-
D-C ra Q Rg V I I la _T7 U m&a( roS''g apem .
CONSTRUCTION INFORMATION:
Additional work to be rtormed under this permit-check all Etapp y:
�HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric F]Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:2 l-16 S . Ft.of First Floor:
Cost of Construction:$ I�, n Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: I
Address: 201q V,0 1. mld(.0 =u M• Company: (
City::B . Qi rA-rP State:CIL Address: 4;0- u(ti & 1, {
Zip Code•3�S) Fax: City: State: F
Phone;No. Zip Code:34)q4 Fax: 772 2-ST U7 2•
E-Mail: Phone No.'_
Fill in fee simple Title Holder on next page(if different E-Mail: •P II I�p VQ' �(�-,'�C n Darn
from the Owner listed above) State or County License: CLf_►.V033�2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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 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,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
ignature w ntractor as Agent for Owner gnature of Con ense Holder
STATE OF FLORIDA STATE OF FLORIDA,-
COUNTY OF (i 41!1 COUNTY OF MVh TN✓1
The forgoing instrument was ack owledged before me The forgoing instrument was acknowledged before me
this day ofvi117 20 �Zby N� � this'L6day ofi2CQif'1?bP1- ,20 by
-4 \_ N� `
(Name of pers cknowledging) N (Name of p on owledging) ¢LL N
lJJ at N a tll Xk N;g
wccn0 woo
2'- 'i LL"—' -•L
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(Signature of Notary Public-State of Florida) jE o a:iE (Signature of Notary Public-State of Florida) o ,
Personally Known OR Produced Identificati n "'m Personally Known OR Produced Identification emu'm i
Type of Identificati Produced Type of Identifica on Produced
Commission No. (Seal) ° a Commission No. (Seal) o_
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
INITIALS