HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater Yo Permit Number:V1 oa.-d a33
RECEIY'rD FEB 101017
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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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S U h
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°,PROPOSED IMPROVEMENT LO.CATIQN ,. zm
Address: Is 1.4KC VISV-A -n-&L Zoo , Po2T ST LU r-I
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Legal Description: VI SFA ST LIJ al G J03I hfd is- tact( Wt 3&2( - I ZZ 7 1
Property Tax ID#: ,LT- Soo- OZO7,0oo / Lot No.
"Site Plan Name: �/VaN204- Block No.
Project Name: /v, z)A'#-.) I
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Setbacks FrontBack: fV �- Right Side:T Left Side:—A-A-
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tETAILED DESCRIPTION QFW�RK
1 EXIS rri�✓6 �✓G�E� SG�9-g � ��r=
CONSTRUCTION INFORNIATIO'N
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Additional work toe e orme under this permit—check a appy:
HVAC Ei Gas Tank 0Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: _ SFt.of First Floor:
Cost of Construction:$ #700 Utilities:cn Sewer Septic Building Height:
OWNER
/LESSEE t CONTRACTOR x
Name No.-V JC NW14- Name: M'Gi*Y416c (Oc�D�wlnl
Address: 320. M*/ZQA!E� 00 Company: 74pycei + TZ1z'13r-4A Aiumlmw"
City: I.4WAl State: Address: 1720 Ntnl Fli:i 7?,Il'C_ 44wy
Zip Code: y`733? Fax: City: S;{VA Lr State: F.
Phone No. 7'7Z- &I Zip Code: ?49SK Fax: 692 -`17Yy
E-Mail: -JAW17!;-(D'C'T L_ CnMA16 Cates Phone No. 772 - (792-c�R�
Fill in fee simple Title Holder on next page(if different E-Mail: A41c.L-begE A.(�6�.v e VA
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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S:UPPLEMNTALG(7NSTRUC�lt�►IV L6NLAIN'1N�tI�lUlA1'IQ1� `
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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 failVre to Record a Notice of Commencement may result in y paying twice for
improvements to your pr per Notice of Commencement must be recorded an ted on the jobsite
before the f' inspecti n. I o tend to obtain financing, consult with en r o ttorney before
commen 'n w or co in o r Notice of Commencement.
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Signature of Owner/Lessee/ o act r as Agent for Owner gy(ature of Contractor7L nse o e
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� COUNTY OF `3 /—QC1,A
The forgoing instrument was acknowledged before me The forgoing instruent was acknowledged before me
this` ay of 20/�by thisle ay of 111-12546 20 Z.-,v' by
(Name of person acknowledging) (Name of person acknowledging)
(Signator of Notary Pub lc-State o orida) (Signature Nntary Public-State o ida)
Personally Known _�-' OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. rc._M — Commission No.
ANN .GA MOND Y Py,.,,,, A N M.OAUMOND
MY COMMISSION#FF 173907 • = MY COMMISSION#FF 173907
rArin
Mad Thru Notary Public underwriters .O'
fOF
` o•` Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE Z ( .
INITIALS