HomeMy WebLinkAboutBuilding Permit App - Kimberfyld Ln ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:" `M Permit Number:
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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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: cc //�� ( ` L .
Legal Descriptions i L - - (I. I
Property Tax ID#: 33a1" S� I1 Lot No.
Site Plan Name: �rn;er S1c�eoc� Block No.
Project Name: &AleL
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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[CONSTRUCTION INFORMATION:
Additional work to e performed under this permit-check a apply:
F]HVAC Gas Tank Gas Piping 0 Shutters Windows/Doors
F]Electric ❑ Plumbing Sprinklers MGenerator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$
Z�yb ?j. 2 Utilities: Sewer Septic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name Name:W111,0M T. 4.
Address: (7d Company:
City: ;n L uciP State:,_L- Address: ( v
Zip Code: 34-t 96 Fax: city: M_)01-6--c State: e�
Phone No. Zip Code: ���-S�' Fax:
E-Mail: Phone No. -a5n - e�_�Iaco
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI N 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: _ of 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.
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Sig -re of Own / oL ee Contractor as Agent for Owner Signature of Contrac icens de
STATE OF F OR DA STATE OF FLORIDA
COUNTY OF I COUNTY OF _S+, L.ur_ie
The forgoing instruyment was acknowledged before me The forgoing instrument was acknowledged before me
this l-7 day of--�k U6 U ;3 20 2t by this 1-7 t!day of %6+ 20 by
iL a 4414 1 S� O cc
(Name of persona owledging) (Name of person ack led
(Sig atur ary, 7duced
o Florida) (Signature of Notary Pu lic�- tate of Florida)
P sonally Known � Produced Identification Personally Known,1�`OR Produced Identification
e of Identificati Type of Identification Produced
Commission No. (Seal) Commission N
Public Stew
V� Notary Publid State of Fonda •r. Caleb
a�ern HHH IIwo
re ellc eau lieu xpi vs
My commission GG 950156 W lik.
Revised 07/15/2014 efR Expires 01/4/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS