HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
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Date: 1 - / Permit Number: 7
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: /� //p
Address: 3 13 1}TZ/j a/f/c ✓3�1 L��CI" Rc/V d. �12- I I C ACC rt. 3 r /p
Legal Description: R E l PL Ol- rVI L 7- f/F/ZGt .S�f-olt tT-/ IV)rJ/"- 8 L K35-t f7'6
Property Tax ID#: 1 Y,36 -6 02-oda.3 - 000-? Lot No.
Site Plan Name: Block No.
Project Name: 1 .(� L ✓�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: � � 'AC,�CA4
1200r- TO _51H1 'tt S_ oU� - k
CONSTRLICTION INFO ATION:
Additional work to be performed under this permit-check a apply:
❑HVAC Gas Tank ®Gas Piping _Shutters Q Windows/Doors
Electric El Plumbin r, ®Sprinklers Q Generator Roof Roof p"dch
Total Sq.Ft of Construction: ,ram-T`�� S .Ft.of First Floor: 7
Cost of Construction:$ NOa� , r
Utilities: Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /h?A�M'4 fw P 1 P 141/Lj Name: 0-
Address: 9313� �A/gdLAILI B E��N ,I� W Company: EM §/GL
City: �I L%kC,6 State: r-L Address: 9LAC VFA10 f_ ST D/
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Zip Code: ',3Ll L//y' Fax: City: SOP-1 T Z l2 State: r-L-
Phone No. Zip Code: 3 3 Y/ _Y Fax:Shc- 7LI8'03 9,L
E-Mail: Phone No. 50- 7/9- o Y 3 Y
Fill in fee simple Title Holder on next page(If different E-Mail: Te/h B1 CK (2&M 4l Z, CoAJ
from the owner listed above) State or County License: GeG#13 2 .CY 7
If value of construction is$2M or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRU ON,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: Tip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lude Coun�y makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in oon ict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
with
structure.Please consult 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 . h lender or an attorney before
commencing-work 'or recor our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STATE OF FLORIDA7 /�� STATE OF COUNTY OF FLORIDA
COUNTY OF C-f /
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_jlf day of T�llA_ 20 Eby this-/ day of 1� .20 1 7 by
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(Name of person a owl . g). (Name of person adm edgi g
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(Sign re of Notary Public-State of Florida) (Sign re of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Knowp� OR Produced Identification
Type of Identification.Produced Type of Identification Produced
GraffQ o eesen`J�µYPp+w b J••�¢YPG�i Oral 4 •A :e.� g 1.®deeSen
Commission No. ex° Qn=C0WMI8(&WFF022827 Commission No. COMPd(SSION FF0228?_
EXPIRES: MAY 30 2017
'.� woe y��•.....p��;;EXPI RES: MAY 30,201
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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