HomeMy WebLinkAboutBuilding Permit Application WN
ALL APPLICABLE INFO MUST BE COMPLEI ED FOR APPLICATION TO BE ACCEPTED
Date: ( 7 Permit Number: ����•—��3�
_
RECEIT-M FEB 212017
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 ,
�t
PROPOSED IMPROVEMENT LOCATION:
Address: cJ f ' ��11.Qr?� �- 1'I t�.�� El . SUCLU
Legal Description: tL°`'✓ R-IVC& 04A S_u Lo�S 3S'; 3io �.v�l 3?CMO�� 3K�OtS)
(o(C 3132 _2scs
PropertyTax ID#: 3qo Z'UOZ —0141— 000 —l Lot No.
Site Plan Name: 1yeJ6e r Block No.
Project Name: N eJbV
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check a apply:
�HVAC Gas Tank Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing OSprinklers E Generator E] Roof lZ Roof pitch
Total Sq. Ft of Construction: 11000 Sq. Ft.of First Floor:
Cost of Construction:$ 1!3.5, jU Utilities: _Sewer Septic Building Height: /S
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: I13 ��tic-Fce� Dr�vL Company: P&f10605 (�
City: �aYi �►�J� State: Address: '-7-7LP
Zip Code: ��{k�2— Fax: City:5-121 State:
Phone No. 1 V� Zip Code:30a'a J 1 Fax:�oZ 4Lg /J/J
E-Mail: V� 40k,Covw�, Phone No. gr::n qla? jmo
Fill in fee simple Title Holder on next page(if different E-Mail: f5 0&-L
from the Owner listed above) State or County License:.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. :�y
i° R
SUPPLEMENTAL CONSTRUCTION LIEN, LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: W--iol l m,n¢2l(fvc LL.C. Name:
Address: nJ NQw Yv(LV_ a Address:
City: o v�. State -"� . City: State:
Zip:r3 27Zy Phone. 3 (. Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of Applicable BONDING COMPANY: 1iNot Applicable
Name: 1J l Ar Name: "1 4
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
ors s
Sign ure o Owner/Lessee/C tractor as Agent for Owner Signatur of Co ractor/License Hol
STATE OF FLORIDA 0 STATE OF FLORJQA COUNTY OF 'S S*- L u VV C%�c 1$ COUNTY OF SS
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this A&_day of T- 20 Q-by this 2l.1 day of V--%1L- ,20 'Q_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of NotaryPublic-State of Florida)
Personally Known O e cati Personally Known o „a,, ._.
Type of ldentif ce N s Type of Identification '� t aRIEGPIENS s
N. ,•y,•
;P #GG 022023 �
•'•rkh 0. y WIMIS bet ill 2020 EXPIRE D
ES:Deco lters o ceded ¢�ber 18.2020
Commission N �uNetaa�S�raerva Commission No: '"^a 6ncUndeNM�e,�
p
••�IiiN•••• -d y
Revised 07/15/2014
REVIEWS FRONT ZONING 'SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
i
COMPLETE �,�
INITIALS