HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPk ED FOR APPLICATION TO-BEACCEPTED
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Date: S - Permit 4Vurn er:
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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:
PR4P,f1SED IMPROWEMENT LOCATION:;
Address: L-2>0 )A- Q>-
Legal Description:� �itJa ---
Property Tax ID#:3goz- o 0-q Lot No. �Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DCR
ESIPTION OF WORK
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CONS RUCT141 ,{ Fer
pit
NFORMATION
Additional work to be performed under this permit-check all that apply:
_-HVAC Gas Tank _Gas Piping ?. 4 Autters �Windows/Doors
Electric Plumbing _Sprinklers _Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ utilities: Sewer -Septic Building Height:
OWNER/LESSEE. : :.CONTRACTOR
Name W �6 2 9_ Name: Q�cb-''2- X -eo
Address: Company: e U
City: �`'a- C State: Address: l
Zip Co e: �- Fax: City: �J State:,
Phone No.Dc� UAS= Zip Code: Fax:
E-Mail: Phone No. ��
Fill in fee simple Title Holder on next page(if different E-Mail: C-N P(t C e i� 613
from the Owner listed above) State or,County License:�-c nic }. 1 115 6
If value of construction is$25013 or more,a RECORDED Notice of Commencement is required.
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SU.R.PLEM.ENT�4L CONSTRUCTION Ui N LAW INFORMATION: 3
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 wol•k or recording our Notice of Commencement.
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Signatur Own r/Lessee/ ontract ent fdr Owner Signatur f Contracto Licen er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ V p COUNTY OF�� I V L.;
The forging instrun ent was acknowledged before me The forgping instrument was acknowledged before me
this day of_ 20 Eby this day of 20 r by
n�-�V• U,\2 can2`. l� .
(Name of person ackn wledging) ( me of person ac owledging)
{Signature of Notary Publi State of Florida) ( ignature of Notary Publi State of Florida)
Personally Known_ OR Produced Identification Personally Known 7OR Produced Identification
Type of Identification Pri Type of Identification Produced
MADE LA LUZ VeUkSCO
Commission No. •'e.MY C ION#00050399 MA DEL VELASCO
a9� Commission No. ? •'
EXPIRES November 28.2020 -"--MY COMMISSION 0 GG050399
. EXPIRES November 28.2020
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLET Y7
INITIALS