HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO
t MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : O` ' ` ^ 102. 1 Permit Number:
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 : V6SO 'S (�cew Or. IAOS :T � i 4nnGhr FL ? TICy
Legal Description : Qekimcly 7P; cj�u n(K Rtiacl j f50�t!- Lips
Property Tax ID #: SS3y ' �O � ' 0054 om • S Lot No.
Site Plan Name : Block No.
Project Name : _ OV_-7xb
Setbacks Front Back: Right Side : Left Side :
DETAILED DESCRIPTION OF WORK :
Ntvkace. 3 Vj% hd bv+r - r 3 doors -to :rmPaut
CONSTRUCTION INFORMATION :
Additional wor to a erorme un ert ispermit - c ec a apply :
� HVAC 11 Gas Tank []Gas Piping Shutters E Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction : p p p ScFt. of First Floor:
Cost of Construction : $ 38 � L l 6 �O Utilities : Sewer 0Septic Building Height :
OWNER/LESSEE : I/?� CONTRACTOR :
Name I nob 4- Z)Ui s E 2oc Name : TQSM Svnkmef s
Address : P(v5G Dr' , yuir Ilea Company: %A) iIl\ 04B 3 't 000r7 be ign Gmier
City: 3e_ po;cl� NrAyu State: FI Address : S(p ` 7& n ,:ft1r QCaI^Y OCO g" . r
T
Zip Code: 3q j 5 '';` Fax: City: -
—t �T u�Or"�r' State : F/r
Phone No. S ) (v 'y Lc� q �,C? `� Zip Code: S7 ({C (g Fax: S (01- JVA a 2SI
E-Mail : t oNcs @ TII ll }L+VA+1i tA` +� ceM Phone No . SGI[' '141 '16 &r
Fill in fee simple Title Holder on next page ( if different E-Mail : PEXIWIl s 6D y f o{alc�p1 _ GCYh
from the Owner listed above) State or County License : S[ ( 13 LIS 722 3
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 con flict 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 p&mit, 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 a attorney before
comWenginMork or recording our Notice of Commencement
s
Sign lure o Ow /Lessee Contractor as Agent for wne ontractor/License Holder
STATE OF FLO '1 STAT F FLO A
COUNTY OF 6u4i n COUNTYOF � �BRG�
The forgoing instrument was cknowledged before me The forgoing instrument was acknowledged before me
this day of CPC r 26w by this DL day of 20 2t by
_�Galj i t4 �enl � � f2° `� 0 rarpn Sunnm2l'S
(Name of person acknowledging ) (Name of person acknowledging I
1 YIrA �,1 ".t�'V1Q1^0
(Signature ofJNotary Public- State of Florida I (Signature of Notary Public- State of Florida I
Personally Known OR Pr uced do, ication 'e Personally Known ,�OR Produced Identification
Type of Identification Produced Q ✓/do, L +1L Type of Identification Produced
N 0YP04 MARYLEEMATRl9
Commission No. 4y ,< MMISSIONNGG064040 Commission No. (Seal)
Po` EXPIRES: March 0, 2021
ru UU0901 Notaly SeMcea Michael Miens
Revised 07/ 15/2014 . My Conxi iaaion HH 02SON
Expims ow=024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS