HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: E3 "' IO - 1-7 Permit Number:
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Building Permit Application a3NNVOS
Planning and Development Seivices-
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 1,1 - • �I,6u)Z
PROPOSED IMPROVEMENT LOCATION:
Address: Q(om S. oCff)n -i)r (_In i+ 4o(D
Legal Description: F_MDrc condor I I n I urn 11 n I i L(mp
Property Tax ID #: 4-'D( V_- (n2( 3 - (-U/--t-- C_`
Site Plan Name: ��t�r('S'S CQI' do _
Project Name: \)L"1hue (^ tsidt nC(
Setbacks Front Back: Right Side:
('DETAILED DESCRIPTION OF WORK:
►Remove and rep[ac2
117nj m►PWr �Z I
I Lot No.
Block No.
Left Side:
S,fdI ng Ghass dcors ,
CONSTRUCTION INFORMATION: -
itiona wor to e e orme under tispermit-check all apply,
�HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
0 Electric Q Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ps �� ' Cp
S Ft. of First Floor:
Utilities
:Sewer�Septic Building Height:
:OWNER/LESSEE:
.CONTRACTOR: ,
Namedc4yYy_'�' MROUlcr
Name:
e
Address: Q(Q t M') C1:�-: cyeon --[)r'• (initqYz
Company: I - e
City: " 1Prn�r) - Ff-W- h f State: F L
Zip Code:-aWg1,5-7Fax:: n—,J 5
Phone No: 77-72-
Address: --I Jr7i1r S:F
City: 'r,4 }l In:1 ...: ❑ -state:r�
Zip Cod6-"S40 :3 "Fk,22&0 -OLUD
Phone No-.—�'ZB�D
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: I�Prrn IbR • o I f1,CSPf
Q5 Q�(1(l� P
State or County License: 1
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If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not 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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 a osted on the jobsite
before thef"ns ion. If you intend to obtain financi consult with lender a attorney before
as
STATE OF FL
OUNTY OFORIDA (fla i COUNTY OFORID� 0-14' In
The fo oing instrument was acknowledged before me
this -Uday ofj6d I Cl I A 20 aby
I -k avant
person acknowledging)
---� OQJ, 2Ji djyIo ,fy
(Signature of Not Publje- State of Florida )
Personally Known �// OR Produced Identification
Type of Identification Produced
Commission
KELLY WIDMAN,
The forgoing instru ent�,was ,acl+nowledged before me
thisoZJ day of I (,� 20 L by
z d Ui Pr k
(Name of person acknowledging)
AIe 0g ?-,—Xyr&y
(Signature of It
ary -Pub/lic-State of Florida)
Personally Known -- OR Produced Identification
Type of Identification Produced
Commission
KELLY WIDMAN
U• •iE Commisslon # FF 9292M • �''- Commission # FF 929255
My Comm. Ezplres Oc
Revised 07/ -y, My Comm. Expires Oct 20, 2019
1� ,µp.� t20; 2019 ,?a, tor'
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REVIEWS FRONT
COUNTER
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
ZONING
REVIEW
DATE
COMPLETE
n
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INITIALS