HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t1.
Date: Permit Number: `1 d 135
RECEI v _:D JAN 2 4 217
Building Permit Application
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 _ 0
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED fMPROUEMENT 4
Address: Q9117 CaniQX-0Y.
Legal Description:,. Monh- Cc,rlc3 Cmm±L1j Chrb-un(V (7Ae - lo-{- I TC
i
PropertyTax ID#: 11321- `r?ol-Cors-Ooo-Z Lot No.
Site Plan Name: Block No.
Project Name: (AnAo- V-jA-IrAl
Setbacks. Front Back: Right Side: Left Side:
DETAILED DE�SC•RIPTION ®F V1/ORK: '
Re,Vr10�2 e �k��'►� 1e `( Aftyv 5c-ts4oy'1 rtes 11 c, 24-ic, -'v Gv\ynif ll'MtAc,\ fW-A'�
54SAO",
CQNSTRUCTION lNf=ORMATION:
Additional work to be pertormed uncle this permit-check all that appy:
HVAC _Gas Tank _Gas Piping _.Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof ® Roof pitch
Total Sq. Ft of Construction: 5)00 Sq. Ft.of First Floor:
Cost of Construction:$ 011,$60 Utilities: —Sewer '—Septic Building Height: ll
O NERjLE=-SSEE: C®NT ACTOR:
Name _t01), V1,4e_ Name:Al lconap tam
m
Address: 0� 9S -Conies Dr Company: Glf*e_ 9-oo-ALA) stjy4lows ill
City:. Till )OCCee. State: FL Address: `Ela 5E G»Col✓J zhil
Zip Code: 3M-., Fax: — City: 5•1tna✓k State: fL
Phone No. Zip Code: 34yq ll Fax: 132- z$-Oz*4Y
E-Mail: Phone No. _7R1-h03-1A0(
Fill in fee simple Title-Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CE�1?3o35�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1:1 IN
SUPFLENIEN,ITAL CONSTRUaC�T(40N LIEN LA�,W IN!FO.RtMAI'l®N:
}. „
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 thepermit 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
Signature o §see/Contractor as Agent for Owner ' nature of Contrac or -cense Holder —`
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF IYIu✓I1>'1 COUNTY OF Yn0Yjr1>1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9AL day of &AU" 20 Lby this-24 day of 00a 20 (- by
(Name of perso acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally Known���OR Produced Identification
Type of Identificatio Produced Type of Identification Produced
Commission No. Commission No.
=o.rPya�ciTHERESADERITA • THERESADERI
+:
MY COMMISSION#FF 062929 rr MY COMMISSION#FF 2929
aF Bonded Thru Notary Public Underw tern EXPIRES:liobei 29,2()17 =n; ° WOW er 29 017
�� F,Q f���;1�` Bonded Thru Notary Public Un rv�riters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS