HomeMy WebLinkAboutPERMIT APPLICATION ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a— 1 Permit Number:
S' j J
•
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 y
PERMIT APPLICATION FOR : To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION :
Address: ) V SQG&SN LcstA5 %IV LFps PtQtcp kq, 7441 s l
Legal Description : QL 34 3 1 ft6w at
t oT falytS '50m ts`, k d %W Cgl t«a 4rt 4) f o 13 AC sa 6679F ) ( eR 37 bz IS6S r
Property Tax ID #: 13bfo " S01 • y 7 ' 000 Q Lot No . t-1
Site Plan Name : 1
Block No . l
Project Name : n27ftm r—a ? J
Setbacks Front Back: Right Side : Left Side :
DETAILED DESCRIPTION OF WORK :
?NgkoLOL "7 v4@% ndovJt -t-o Y VLcA'
CONSTRUCTION INFORMATION :
Additional work to be erorme under t - checkispermit a appy:
0HVAC � GasTank ❑Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator El Roof = Roof pitch
Total Sq . Ft of Construction : S Ft. of First Floor:
Cost of Construction : $ �SZ3 . 2l Utilities:CnSewer Septic Building Height:
OWNER/LESSEE : CONTRACTOR :
Name %W %A V FAO y Name: �QSt�f� S�lfvwvy� {�
Address: (0\ 1% SID'a �( �� ullis Company: l,��� y�Cyp,
City: �vIFA YVt urep" State: Address: (Q�S�p��{ r (1pW1 2
Zip Code: Ltq'31 Fax: City: 17VTi "Y State: L
Phone No . �1 �L0 ' 2`6�i qq2q Zip Code: Fax: 5fQ (e *7 !j7 -25;3Z.
E-Mail : Phone No. 561 - ??"'At - 'i fts
o.
Fill in fee simple Title Ho der on next page ( if different E-Mail : C eYnM* *4`a A ard '�-ae 1 Miff f ofY�
from the Owner listed above) State or County License : Se.L 13 ) 1S '1 222�
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 I will, hn allorespgcts, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendmertts.
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 toyour property. A Notice of Commencement must be recorded and po ed on the jobsite
before the first inspection . If you intend to obtain financing, con ult with lender or a rney before
commencing work or recording our Notice of Commencement.
J44L
lh�lezi L E 5
4
Signature of Ow er/ essee/C ntractor a ant for Owner Signa of Contra r/Licens
STATE OF FLORIDA� STATE F FLORIDA
COUNTY OF i'GQMr1 COUNTY OF Q[i�gp RtC�Ir.
The forgoing ins ment was acknowledged before me The forgoing instrument was acknowledged before me
this n day ofIX4tllfr�MW 20Z'Qby this �7 day of (:k (,it, r�b� 20 a by
1111y CLsty\ TzVj1Py\ANzrs
(Name of Oers n acknowledging ) n (Name of person acknowledging )
(Signatfirej Notary Public- State of Florida ) (Signature of Notary Pub siicl State eoof Florida )
Personally Known \ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. � IS Ion Commission No. (Seal)
o sAug# HN02024
OFF Iop OwNiTWusudgemotvysemm
Notary Pablb Stab of Fbrida
Michael Vk m
Revised 07/ 15/2014 f rm NOh ry Public Sham of FkrJ& My CartuNu on HH 029904
Michael V' Expirn 0505f 4 l
M 0291164 �v
REVIEWS FRONT ZONING SUPE EGETATI N SEA TURTLE MANGROVE
COUNTER REVIEW REVIE REVIEW REVIEW
DATE
COMPLETE
INITIALS