HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE`�a,�, APLETED FOR APPLICATION TO BE ACCLU . �-D
Date: 3'�� ^ i Permit Number:
stt'., � , S$ Lucie COMW
gs iY Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Selectlfrom dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIOIVI:
Address: 5 7 ,Zr54',-A De- 1_a�) L oa
I
Legal Description:
Property Tax ID #:
tZlff !/A9
Site Plan Name:
Project Name:
Setbacks Front 2-Z � Back: 16 Right Side: ! 2 Left Side: 12
a31�I303ti
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
Re,ojiiG.G 1(�'X 1 z r c7 Gar pow+ ��a+ c�a s 1-) loww a �� I%" 1"r•rhrcarn a rlMc,
CONSTRUCTION INFORMATION: i
Additional work to be performed under this permit— check all that app v:
11HVAC
— Gas Tank
❑Gas Piping,,
_ Shutters
Windows/Doors
Electric
❑ Plumbing
Sprinklers ,
Generator
® Roof Roof pitch
Total Sq. Ft of Construction: I Zed ' S Ft. of First Floor:
I
Cost of Construction: $ 2200. oO Utilities: Sewer Septic
Building Height: f
OWNER/LESSEE: `.
CONTRACTOR:
Name OA 6car-r
Name: GL ,- ,
Company: Pre Cr'�>`7a� A j V444 A,,w n=d .SCr'r_2et _'Lv
Address: 2c6U5o (I/Cz. ioS 4h -} c ; r
City:Oke -66 L"e State: F-I-
Zip Code: 3ILI9'7Z Fax: 73 3 -5397
(Phone No. :Z32- Y 70 - $2- 6
E-Mail: CceiG m
Address: S7 ; e, "vK q
City: _ E4 . r`Qr'c e State: FL
Zip Code: x q4 Sl Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: 3 (_
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRULHON LIEN LAW INFORMATION:
i
DESIGNER/ENGINEER- _ Not Applicable
Name: _ v✓e'_J9 5 � ����:^t�,...t,,t F-. -1 ef-.49
Address:136�go 5;V- s* N�,fh <,,1, -, to 1
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
City:
Zip: Phone:
State:
City: 61eri State: !_i-
Zip: 337i6o Phone:-727.-53Z'—C3oeo
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Address:
XNot Applicable
Address: !
City:
City:
Zip: Phone:
I
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 Noticelof 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.
Owner
STATE OF FLORI
COUNTY OF
as Agent for Owner
The forgoing instrument was acknowledged before me
this -t clay of M a ifc L, 20 dby
(Name of person acknowledging)
.I
(Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced rc_py
Commission No.
Revised 07/15/2014
rise Holder
STATE OF FLORIDA —
COUNTY OF ;9- L.(a
The forgoing instrument was acknowledged before me
this 1 day of i' 6[ (&h 20 )g by
Thal Iec Ti')Ie_U'0V- 1 r
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification !�
Type of Identification Produced FG—OL.
@�1PINKSTON•CASTRO I Commission No.
naryblic-State of Florida
Commission N GG 099917
Bonded through National Notary Assn,
tbE AWANDAPINKSTON-CASTRO
Notary Public - State of Florida
Commission # GG 099917
Borded through National Notary Assn.
REVIEWS
FRONT
ZONING
i
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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