HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `� Permit Number:
RECEIV-:D PEAR 13 7017
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:
Legal Description:)-e—AA-\-e !:-' -',�-'kCanrA Tr,c' 12\ L° ond\a — Ser4izQ. h�ccd 22-4
Property Tax ID#: t-1 c,:)O2- S 01- C)y VDj - COl7- q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all apply:
�HVAC Gas Tank fn
F]Gas Piping _Shutters Q Windows/Doors
aElectric 0 Plumbing Sprinklers El Generator Roof N10 Roof pitch
Total Sq.Ft of Construction: SQ. Ft.of First Floor: _CpB3
Cost of Construction:$ , �� Utilities: Sewer Septic Building Height: \
OWNER/LESSEE: CONTRACTOR:
Name Name: D�; CA-)Ca(-d. V
Address: Company: Le r,Y 1?��,,S�P � 2 � 1�-P ,�r LL
City: Stater Address: (p I -1�,jrJ-'-' 1�f
Zip Code: L Fax: City:T:n C-t P;-e:'cC•P Stater
Phone No. ---I ICa- Zip Code: Fax: 4:a
E-Mail: �-,)nnnn� �� �n;r1.� _ Phone No. 'q-:)
Fill in fee simple' Title er on next page(if different E-Mail: �-, ' i o
from the Owner listed_above) State or County License: LCO-n, OCi-4 (":2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i 1
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,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.
�_ 0 Lw, A \1 , '6&U�j L� (A-C &'0'A \), ��� 1"V�-�- s
gnature of Owner/Lessee/Contractor as Agent for Owner Signa ut re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S1. (�,�aQ_ COUNTY OF�S�.. U_�C j!�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Ynacr k 20 13--by this'031. day of tnC,,r(•a ,20 1 by
C�1r''aYd I I cAl iy pQRTN
(Name of person acknowledging) person acknowledging) ;�''` Commission#GG 4 25
soy►" SALLY POR ES =� '" pay C, emission Ex es
y®*__ Commission#GG 47625 �i, vembef 16 2 0
r My Commission Expires "•^"'"
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(Signa6re of Notary Public-State a of N ary Public-State of Florida)
Personally Known_�OR Produced Identification Personally Known�_OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ' (Seal) Commission No. C C\ `s (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS ,�