HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: SLJ l 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
Pk POSED.LNIPROVEMENT,LOCATION
Address=' j 07-5 1 S n c P ari —D t- N Co
Legal Description:
:V:ropertyTax ID#. 'A S 1) 31, -pnicJ-ruoy -`T Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
TOS S T n 7 0 /�lr^�° del �� 0 /.,1 z_ ,:7m
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CONSTRUCTION INFORMATION
Additional work toe e orme under this permit-check a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:li Sewer ElSeptic Building Height:
OWN ERAESS,EE t CONTRACTOR
BVI ame Leis 1M1 'u) \) �c_vrc I nti3) W;\\%'amS Name:. .- . N-�j Lc t,-; IC
99ddress: l o-7 5 1 S b eauj -bK_ L4>7 AS. ::.Company: \-o�w s 1= I-ecTri c,l Se ey rc_-e firi�
10ty: -e N S-e 3fate:, :Address: 15 Nu-)
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WZip Code: '2>L1 q S 1 Fax: CC-ityjQn rt lz�k, Lu c i Mate: 1:: 1
Phone No. �� 9 - 9 5/ �y7 SaG-39`a 9 [Zip Code: 349g 3 Fax:
E-Mail: Phone No. Zia-.�70--`I357
Fill in fee simple Title Holder on next page(if different CE!Mail:;o�nn► \oW S I 9 @.0.01. corn
from the Owner listed above) mate or-TCoun -=License GC /3 00(v3 7 a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C
CTIO
ONSTRUN 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: _Not Applicable 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 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 an attorney before
commencing work or recording our Notice of Commencement.
_Sign re of Owner/Lessee/Agent Signature of Co tactor/License Holder
STA E OF FLORIDA STATE OF FLORIDA
COUNTY OF Y -1 O,r \rJ COUNTY OF YY-, t Q
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this off` day of 20 ]!Zby this day of m cx 20 LS_ by
ct k,J
(Name of person acknowledging) (Name of person acknowledging)
(sigAature of ffotary Public-State of Florida) (Signatur of Notary Public-State of Florida)
Personally Known�Mt7
OR Produced Identification Personally Known OR Produced Identification
Type of IdentificationKATHRYN BUMBERA Type of Identification Produced
FFo9?(336 YPUBLIC � YPUBLIC
Commission No. PAAORIDA Commission No 1� ft OF FLORIDA
CamMl FF097133 Cam*FF097133
EXPIE"30MIS UP.
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS