HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:.!. --t LI—Ls! Permit Number: (?/
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Building Permit Application pe °FL ,g Fo
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
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PVC/Q,D?%
�' �i�J Ca` tY e4t
Residential ✓ .
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: CMM�fe COnC rn ; M &C I UAi{ 3?C
Property Tax ID#:LCi10-,3O-J-( lq?-QQ0-G
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
((�
SCANNED
BY
St Lucie County
CONSC�tUCTION INFORMATION
A001120nal Wurm
. 1.. ems.. aiiv «.,..go— a Y±F
to e erfornied un ert is permit — check
rf:»:.'... • �. .a— �. i'I- max. \-.4n� �l ..L f.:'fL�.v- �'.. i�7 iY ��
all apply: v
EjHVAC
Gas Tank []Gass Piping
windows/Do, ors_
11 Electric
Plumbing []Sprinklers
_Shutters
M
❑
Generator
Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 3aLI d .qg
S Ft. of First Floor: _
Utilities:n Sewer E Septic
Building Height:
O.... W.� R
.Sn \.✓
Name`C. n� khn< <��rl� lJlCKlrl�Af1
, ACTOR
_ W ..'. I. )�:%ICY 5�..
Name.�p= �`t` C:
Address: (d0 3)tWe,
��
Company:: �:4-co C , r-,Q e n" �S
:FiV L
City: � ran KS y', l I e- State: td_ ±7
Zip Code: 53 l a& Fax:
Phone No. �1d(aa -g"7A -50cf6
Address: i_� If in ( —7 S i_�H
City: I &i: y` , wy:�c`r C. t
Zip Code:_35LJ I Q-- Fax: � L,I
Stater'---
C/y'S
E-Mail:
Phone No. 57,11- cr 5' 5 - 4/G5 a
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above
State or County License: L ��0 G r�l
e��iS 3 �•
If I
va ue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
City:., State:
ZIP: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
t ty
whichCis in cOn Mitt aawith any applicable lHome Owners tAssociationl ru es abylaws or anS covenholder
nts that buildthe
or prohlb�lt ure
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 your Notice of Cornrnpnrpm.. f
1
STATE OEM t4/t1C-�ytstn STATE OF FLO IDA COUNTY OF �N e COUNTY OF G 1 no Bec �-P7
The forgoing instru enIt was acknowledged before me The forgoing instrument was acknowledged}yefore me
thislNayof� f N�o 20 fgb
^,rt u Y this day of �PI' . 20 ly by
(Name of person acknowledging') (Name of personacknowledging)
ers
Itw&to
Personally Known OR Produced
Type of Identification Produced tV I
Commission No. I q.5�430
�M s
Revised 07/15/2014
REVIEWS I FRONT I ZONIA
COUNTER REVIEW
INITIALS
(Signatu;e1ofNo ry public- St a of Florida )
_X Personally Known �OR Produced Identification
Mm,. Type of Identification Produced
4SM' Ilel, ANGELAYOUNG
Commission No. * My(."�aa'I)SI0NSFF951069
EXPIRES: Apnl 12. 2020
0 Bonded Th. R.dn,u��.,.. e.-,.....
REVIEW VREV EWON I S REV EWLE I M EVIEWVE