HomeMy WebLinkAboutBuilding Permit ApplicationALLAPPLICABIfEIN MUST BE COMFL^TE ED FOR APPLICAON TO BE ACCEPTED
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Date: ��I / Permit Number:
Public Wo:` S
St, Lucie county, FL
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: II5S- U D GI A -Go 0 4DE Z_- L A K)
Legal Description: ITT S .- : S '
Property Tax ID #: ,3 9 li `r r%C / ^ 000 % U Isr Lot No.
Site Plan Name:=6n_ Block No.
Project Name: COOL. f S C )e C�/i) AG L
Setbacks Front- Back: �J / Right Side_i Left Side:
DETAILED DESN'10WON OF WORK:
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w) sG/z��/li �,ucLOs���, rM►d- I��tl�
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit - c ec a apply:
1jHVAC f] ❑Gas Piping Shutters ❑ Windows/Doors
Gas Tank _
® Electric Plumbing Sprinklers ElGenerator 0— Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
� U 0
Cost of Construction: $ n �� Utilities:] Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name D A-V 1 D 8_5 , CE L L
Name: -FV 14 AJ A4 - AY
Address: /7 JSD 0 f c 3 A- 60 /c> W I-f E,e L L d
Compan"M e C4S %O m APO �
Address: 3/3 t/ 5 ,ct) P/ In f+'%%
City: El P State: ,6e-- .
Zip Code: 3 Y9 �% Fax:
City: Z-- Stater --
Phone No.
Zip Code: J 075:3 Fax-V-?, -�of7 ✓y S-
E -Mail: 1iE?_;! Nrn /+ 4 •coNj
Phone Nq?'l9, 02�0`" 3 O
Fill in fee simple Title Holder on next page (if different
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from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
FA_
fir'_ .. •�
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State: _.25,_
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: hone:
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
improve nts to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the f rst inspection. If you intend to obtain financing, consult with lender or an attorney before
commencln work or recording vour Notice of Commencement.
of
e of Contrz
STATE OF FLO A STATE OF FLORIDA'
COUNTY OF COUNTY OF
The f going instru w acknowledged before me
this day of 20 A by
(Name ogperson acknowledging)
(Sign`atifre otNdta Pu ic- Stat f Florida )
Personally Known Y OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
REVIEWS ! FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
The forgoing instrumel t was acknowledged before me
this � day of 20-9 by
1wV7 C'Veyny
(Name of person acknowledging)
(Signature otNotary Public- State of Florida ) I ,4% . VoF_VUA_P1
1 tj'.e
Personally Known OR Produced Identification
Type of ldentificatio/ 4roduced
/�R�/
Cgpgp�s�nn No l� [ � 5_7 0 (Seal
Notary Public State �f Florida
My Commission FF 914312
Expires 10/0312019
SUPERVISOR I PLANS
REVIEW REVIEW
WILLIAM H DONOVAtd JR
My C— �N � 660935Z
EXPIRES Apt# 12,'2021
VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW