HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: YId U\ ' 13011
RECEI V TH APR p 2917
0
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
},
5,
Address: - ,?R
Legal DescriptionlodtgYL.'-�tY-er -eAtQ42S la U4- tip -BIk- 13 Lat5 3`7-r336rngp S////5.)
or (VQ aws— a-)IpS )3s5'q- &32 : 4-Tss9
Property Tax ID#: 3Ltu,— Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: c l Left Side:
fDEs,t,AI�LED�DS�GoIPTI��N;OE,W,OOMW
qD
N
�•'e `t -1,� ' [ -J r..w �: rr...� i <�t.: r t �. ra A 4';
,.
[ b . 3 ct ? a r 1a
�COIVSrtRUC�TIN INO;RIUTAI'ION
r.1,F. ,1.:
Additional work to be,.performed uncl er t is permit-check all that t apply:
❑HVAC Gas Tank _ Windows/Doors
— ®Gas Piping Shutters I n�
0 Electric 0 Plumbing Sprinklers FI Generator 0 Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ tQ COD . Utilities: Sewer Septic - Building Height:
vt/g
YOfWNER/LESS.• 1 JJ F} > f L 1V �TIJl�AfS�(� f JrN2 �7 1 r Z�I k �E� ✓fit�N
itY.i.'...v CY.....1 [ .,�.J., f .1.' Z; .:.•rt...rY h,�..'- t.- ......aF ..i.. -�? :-.-�, fn S� .�.ht e. �Y yt�f.�J _ �.^u4'l�. s..JJ
Name Name:JL kw-q +RQ.(A r
Address: g0 5 C""S sk. Company: " {L
City: t'� PyeyAe State: FL Addresss: 0 0 �->6x 216,
Zip Code:9(C/8 2 Fax: City: dYi� kQ State_: t-(
Phone No. 5.1 , '1C5o Zip Code:3W9/ Fax:','L g108.1//3
E-Mail: Phone No.135,12-yor 1/1 to
Fill in fee simple Title Holder on next page(it different E-Mail:,)ibW, &j;t'S a (0_ Li 4d.(`Gwt
from the Owner listed above) State or County License: Chr 1 511, S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU,PPLEMENTA.CON'STR'UGTI'01� LhENsLA�W', INEORM'ATI`ON�,
4
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:'
Address:(40 u3 Address:
City: P, St te: City: State:
Zip:�?21-no Phone:'Atp ')2I IV F 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
��— s
S g ature of Owner/L ssee/Contractor as Agent for Owner ign a of Contractor/License Holder
STATE OF FLORIDA S E OF FLON-10-OF012-D
NCOUNTYof . \�(,� J COUNTYof
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 0—by this day of MG1 WN 120 11 by
1 N I COLE iH.Ti Pia t t ja L 5 pla a er _
(Name of person acknowledging) (Name of person acknowl dging)
(Signature of Nota. ublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known V/OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Pr
�.ti►a""i;&.9"� C S UNDERHILL
Commission No. (Seal) Commission No. FF1 .° NotOggQiic-State of Florida
o�*RY AUgf�c CARpLM,J014NO0 `� My Comm.Expires Oct 12,2018
' Lily C0MM15S10N I FF 01157
:' -Po,` Commission#FF 132509
EXPIRES:July 29,
Revised 07/15/2014 �',,EQFr,�P` BaadtdihNBudyetNcltryStrvttte
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REV EW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE Li
INITIALS