HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: Permit Number:
.R �EIV�D JAN.1�7917
Bull ing Permit pplication
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRONstb, IIVIPROUEME`NT LOCATION ' `
Address: . UZ AQ( Al AA' NO -104 W ECAC,14- V'L-
Legal Description: 11-
W I NO N L,(L V I LLAbE7 134 S L1. -UA,(f -fl/Vo -4 SE Q,
Property Tax ID#: tin ( -- e I I -ooi:J -DEDO- 3 Lot No.
Site Plan Name: FiRe Block No.
Project Name: fEL-A k
Setbacks Front Back: I s Right Side: Left Side:
D'ETAILED£DLSCRtPTION.OF WORK k
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rax is►7 irn G GOIVGFZ�S'-A5
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CONS`CRUCTION'I IFORIUTATION r z
Additional work to'be er orme under this permit-check a apply:
F]HVAC 11 Gas Tank Gas Piping _Shutters Windows/Doors
Electric El PlumbingSprinklers [Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
0
Cost of Construction:$ 57bp �7 Utilities: Sewer 0 Septic Building Height:
OWNCONTRACTOR ,.. Ww ..
Name CA—0 I Name: 1MIG4('V*-L_ C-kVQ01&1
Address: 8z- A4;i)(- 44- P4_ Company: 'R%S& IkRe� ML4014INuM
City: IE&SDAI 1 CAVA4- State:?t_ Address: Zo
i
Zip Code: Id Fax: City: '%fUA1Zf State:
Phone No. M071� -7 1 g- 8S9 8 Zip Code: 3N yaH Fax:
E-Mail: Phone No. -1-12 Ot7A Q
I
Fill in fee simple Title Holder on next page(if different E-Mail: IGGF►Q?�_L6��tN/r1) C�y4/¢ao�
from the Owner listed above) State or County License: Co mac/a 4-
If value of:construction is$2500 or more,a RECORDED Notice of Commencement is required.
5UPPLEMENTAI CONSTRUCTION I.IEsNq LAVU
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
I
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 poyffenc ,walls,signs,screen rooms and accessory uses to nother non-residential use
WARNING WNER• ourRecord a Notice of Commencement ay y ult in your paying twice for
improve ents o you proptice of Commencement must be cod nd posted on the jobsite
beforet efir insp ti nd to obtain financing, consu • h I or an attorney before
commencin or r r c Notice of Commencement.
s
Signatur of Owner essee/ tracto as Agent for Owner Signature of Contr ctor/License o
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST (2('f,gZ' COUNTY OF VC/�
The forgo' instrument was acknowledged before me Th�Ny
g instrument was acknowledged before me
this y of /�A� 20/�6y thi of 77%0 20/ by
(Name of person acknowledging) (N�f person acknowledging)
(Sign at otary Public-State o orlda) (Sign atu4�Notary Public- e�of Flonaa)
i
Personally Known ,-'OR Produced Identification Personally Known. --� OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 4'"Y°yam; ANN MOND Commission No.
—MY COMh71SSI0N 9 FF 173907 r
•. :a€ EXPIRES:December 7,2018 ti'" pis ANN M.GAUMOND
��•...: Thfu fideFWAM .= MY COMMISSION if FF 173907
•, P, EXPIRES:December 7,2018
Revised 07/15/2014 - q;{tgQ Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE ti 11 1�
INITIALS