HomeMy WebLinkAbout1705-0571 BUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '7
Date: Permit Number: I IDS • 057 !
Building Permit Application MAY ? 5 20
Planning and Development Services Pe
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Building and Code Regulation Division 3t cI?
2300 Virginia Avenue, Fort Pierce FL 34982 re o
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential `�"'�e
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: ,
If A
Address: lip
Legal Description:
Property Tax ID #: 02 Y • QQ/& • 5- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Li Zo
�I- r.04.f-okk 117>ct
� AK'S114/1
r
(C-1-0-14STRUCTION INFORM ION:
AGOmonai worK to oe errormeu unuer finis permit - u
0HVAC _ Gas Tank ❑Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction: b OC13 0
Cost of Construction: $ �b
an umappry:
_Shutters Q doves/Doors
Generator Roof S Roof pitch
S Ft. of First Floor: _
Utilities:nSewer Septic
Building Height:_)
OWNER/LESSEE:
CONTRACTOR:
Name �- a W
Name: ��-
Address: C' c.P �
Company: S v'
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City: State: u-
Address: IMP
i
Zip Code: Fax:
City: .S t1
Stater
Phone No.
Zip Code: 3YYS'7 Fax:
E-Mail:
Phone No. I
64sr —a L
Fill in fee simple Title Holder on next page (if different
E-Mail: S E u t
(¢4 i
from the Owner listed above)
State or County License:
Z-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN
Name:
Address
City: _
Zip: _
EER: Not
Phone:
FEE SIMPLE TITLE HOLDER: , ILLdt Ap
Name:
Address: u
City:14
Zip: Phone:
Ad
COMPANY: _ Not Applicable
State:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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 vour Notice of Commencement.
�FAwwATT�� �So;�"Anvl%.� RAYI<wvesl TV-11-
Signature of Owner/L as Agent for Owner
STATE OF FLORIDA
COUNTY OF W-k.,-r-I IJ
The forgoing instrume t was acknowledged before me
this!�y of Rk&V 20 /aby
Vame of person acknowledgine I
STATE OF FLORIDA
COUNTY OF - .R A,'Lri�
The forgoing instrument was acknowledged before me
this a y l`day of W-y 20 .1-7 by
S�VFJJ
(Name of person acknowledging)
Sigriat re of Not Public- State of Florida) (Signature of Totar f Public- State of Florida )
Person y Known OR Produced Identification Person/ally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced F t_'bfl1 VI;6t.. t;�
Commission No. fission No. (Seal)
tial� °y6G LORI B. JENI4NS
°R MY COMMISSION # FF 952 1
,LORI B. JENKINS
Bonded Thru Notary Public Underwriters COMMISSIONMY
sf ;fk ry EXPIRES: February 13, 2020
Revised 07/15/2014
~?`oo f`�`. Bonded Thor Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS