HomeMy WebLinkAboutBuilding permit app ALL APPLICABLE INFO MUST BE COMPLETED_ FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �Q
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION -
_ - -
Address: 176 75 CO ACM114„,6 2 X.b : 'x'OAr PICA CE /- 4 3 q S
Legal Description: OAAg w 4 `f Cg R 0✓L ES 7--V T S - VIV> T gL K 6
_(0, 23 46 oA 3Vq-8 -a1173
PropertyTax ID#: Z 3 7 b l-p O ' OOQ �3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
� DETAIL-EDD- -E-S't'RI'P'TI'ON-,O'-F'WORK:
soflo5le rAo le 9,0 v'er"J a" awe
w/ ;1' / C-44,nd 4s S e Q rn
-CONSTRUCTION INFORMATION
_ -
ACIClitional workto b e erformed under t is permit-ctieck all apply:
0HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: 3 00 S .Ft.of First Floor:32-00
Cost df Construction:$ .5 00. d a Utilities: _Sewer E]Septic Building Height: kt t- _
OWNERAESSEE CONTRACTOR -:
Name Name: ✓ AI V _
Address: ' Company: U46 M ` tgs NG '
City: t State: . Address: 3`71 I- 6 2 W)9
Zip Code:39L)U's Fax: City: Stater
Phone No. 11_1Q_Qh 6 ^90D S Zip Code: Fax:p
` E-Mail: Phone No. l / g3
Fill in fee simple Title Holder on next page(if different E-Mail: t o h"'F v e -In
Y•
from the Owner listed above) State or County Lice
nse:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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: 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 1 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 Acorog your Notice of Commencement.
~� s
Signature,of Owner/ sse /C ge 'for Owner Si atur of Contractor/L ense Holder
L --- =
STATE OF FLORID l STATE OF FLORIDA
COUNTY OF L . LQ6%e. UJi-1 0 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged,before me
this ZO day of -,So^L) (T , 20 Eby this IS day of 34"W 96 4 ,20 a by
(Name of person acknowledging) (Name of person acknowledging)
Si =fur._of_NI ary_Public-State of Florida) (Signature of Notary Pu lic-State of Florida)
- Personally Known ✓ rOR,,Produced Identification Personally Known OR Produced Identification
Type of Identification Produceed• r Type of Identification Produced
Commission No. �J Notary Public St to of Florida
mission No Snyder Seal)
2040 Notary Public State of Flori a a My Commission EE 86E892
Cellen Aguilar � '. Expires 01/27/2017
Y C.ornmmslun
Revised 07/15/2014 Owr Expires 06102/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ' REVIEW REVIEW
DATE
COMPLETE
' INITIALS •