HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � r Permit Number: WY C)Cq I
Building Permit Application MAH, u Z lull
Planning and Development Services
Building and Code Regulation Division +,<<.i i RIG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Co nty, 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
PR,OPOSED ,IM,PROVEME�NT.�LOCATION; °`
Address: I Alfl/� f fla CA— ( C�`f �0(�1NL�l1IL_L J. /6yAe- , .3L/q,5 7
Legal Description: l Irk/' Dy- 0n�A —c0a-
Property Tax ID#:_Y Dq- �70 ! /-I p(ol,'), - 0(00- O Lot No.
Site Plan Name: Block No.
Project Name: G ✓
Setbacks Front?,oo Back: 6, I Right Side:14in_Left Side: !6 r13
DETAILED DESCRIPTION OF WORK, j,
.
U ��� /� � Yeo��� �1�mBia��i � �� ��,oRyw ,1,CfP-4/00/a
TA V
CO'NSTRUCTION.IN,FORMATION.
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing []Sprinklers ❑Generator Roof to z Roof pitch
Total Sq. Ft of Construction: y S . Ft.of First Floor: l A-1
Cost of Construction:$ r� Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name G Name: ,Q
Address: A` Company:
City: i State: Address: _�
Zip Code: 3qzw, Fax: City:�j�r�� /� State-&,-
Phone
taterPhone No. 77) Zip Code:;3��q�/ Fax:
E-Mail:Afga�Zj��r�/�� 13J1°, CaX Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: tc cr�/47r 7/ 0-!Y&D�
from the Owner listed above) State or County License:(,ISG, W:W
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-may '1' ti
1
SUPPLEMENTAL
ON LIEN LAW INFORMATION-,
�,, :� .� 4"�. ... '
..-
DESIGNER/ENGINEER: . _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: C '-:G D G Name:
Address:'96L k = Address:
City:rl, - State: 'L, City: State:
Zip: Phone: z �l D�-�'7,�1 Zip: Phone:
L
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.
s
Signatur of Owner/Lessee/Contractor as Agent for Owner Sign o Co ractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF I Lkc�e. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 0-by this day of 20 �L_by
_�\&< � T-A�,kC, %�LkL
(Name of person acknow edging) (Name of person acknowledging)
�2ICS Gi'- _
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known / OR Produced Identification Personally Known `� OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.- ,a+—a PAME� CENK
Notary Public-St�te of Florida Commiss'"' ,,`fir p4e,', P LAS.CENT
Commission FF 242410 �•io %; Notary Public-State pt Florida
L21b
My Comm.Exp res u , Comm sionRevised 07/1 „� ,` BondedthraughNatlonall�taryAssn. � o;= My Comm.Expires Jut29,2Qt9,
�' ,° � Bonded through Natlonal Notary Assq. . .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
cg
U�Lv�