HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date: I rJ CJI L( Permit Number:
Building Permit 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: :33S
Legal Description: Pc�)Z— LkyLk-F A t31Y 3-1 LO 7 C�A4P
or C �-Ib1 - ti►�ba�
Property Tax ID#: '34 l9 —-�-30 (20-1 a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AX_
dC
i2d1()G
0-40
CONSTRUCTION INFORMATION
appy:
Additionalwor to e e orme under this permit—c ec a
HVAC
11 Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 1���U.y D Utilities:n Sewer ElSeptic Building Height:
OWNER/LES5ItE:. CONTRACTOR:
Name Name:
Address: Sas- SE T�?_G��Q( u.1�r� Company: kv))-
City: QYT SV-U_k_Qae State 'i Address: Ajo
Zip Code: I 12 Fax.1-1 .3310 Z��3Ci� City: a� �sr Stater
Phone No. J gC71 .a/1.kms( Zip Code: 1
E-Mail: C��C�1CG�- '� c�i�c:O�LVC�\�1cX�.('yr�. Phone No. C 5-5;,4.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C.4�(` l`yj 1 �U
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGNER/ENGINEER: �: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: �jL Not Applicable BONDING COMPANY: Q7 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 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 a attorney before
commencing work or recording our Notice of Commencement.
"Z� s
_Sig a e of Owner/ ess gent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI
COUNTY OF COUNTY OF a,\o'-1 (�je y,
The forgging instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1—`day of (Y 20 S by this (LFday of MCV 20 15 by
(Name son c-knowl dgingU orrac nowledging)
0,
a ure of Notary Pu c-State o FloriPuda) aication
(Signature of Notary lic-State of Florida)
Personally Known N^^ OR Produced [dentPersonally Known ?Q OR Produced Identifica ' n
Type of Identification Produced Type of Identification Produced
Commission No. ommission No. ea ELEN DOWNING
HELEN DOWNING =`PHY Py9�
IllJ0.10
aiq�•"•"''°ye��.; • ''*= MY COMMISSION,�FF 036576 �
* ',�_ MY COMMISSION I FF 036576 EXPIRES:July 21,2017
EXPIRESPAJ
TCS, Bonded Thru Notary Public n e
pf"�°c' Bondod Thru Notary Public Underwriters P.�"
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS