HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COki,Ci TED FOR APPLICATION TO BE ACCEPTED Z/
Date: 21 20 / $ 'CANNED Permit Number:
iIn1p,Ccan 1
Bu Iding Perm it.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 v
PERMIT APPLICATION FOR: 122f�`� �,will
PROPUSED INPR®VE ENT L®CA IQN:
.
Address: 9 leandx Ave F4• •'teCP L 9 g'2
Legal Description: 6,U rn l / 70/,
Property Tax ID#: d9-go-D40 --Q DA3 Lot No.
Site Plan Name: Block No.
Project Name: +LZ
Setbacks Front Back: Rigf�t Side: VIA Left Side:
DETAII.Ed DE�SC IPTION OF UI/U :
2'- S' ? a,A W'a 11 PziQ2IY, ?b% AA,?-TWe5Qaite. G%L
Ct�71d RU TIQN I FOR WIN
Additional wor to a performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas i Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: JU ZA Sq. Ft. of First Floor: Dll 1A
Cost of Construction: $ 9�500 Utilities: —Sewer _Septic Building Height:
I
EWiN,ER/tLE-S�SEE:
C �Ni�RAT�Q:R:
Name PA; Le la-f-xR Tu ) cz bxoquA Au, d-c
Address: /a ll bL&_A 4A Ay v •
Name:
Company:
Address:
City: F4. P' we_ State: FL
Zip Code: -5q9 77- Fax:
City: State:
Phone No. 77,t - q2 F •- D 1 S$
Zip Code: Fax:
1
E-Mail: d mG/TenrLa
Fill in fee simple Title Holder on next page ( if differed t
Phone No
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notic i of Commencement is required.
PPL MENTAL Ct?NSTR
ION LIE ' LA
I'NI'ORMATION;
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
I
Name:
Address:
I
Address:
City:
State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
I
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain 'a permit to do the work and installation as indicated.
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 Ito obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Ow er/ Lessee Contractor as Ages6. Xqr Owner
STATE OF FLORRIPA.
COUNTY OF /-,Di? uxm ?I L%-f r
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrury�e t was knowledged before me The forgoing instrument was acknowledged before me
this o2� day of 20& by this day of , 20_ by
GZ
(Name of 1
acknowledging)
�•' �C�sa:�i7Yt►�III�
Personally Known OR Produced I
Type of Identification
Produced_
Commission No. 3
MARYANN M. PREZZANQ
REVIEWS
RECEIVED .
DATE
COMPLETED
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known _
Type of Identification
Produced
OR Produced Identification
Commission No. (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVI REVIEW REVIEW REVIEW