HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN O MUST EI COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� Iv Permit Number:
•
Building Permit Application
Planning and Development Services =
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)4627-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 10 15k C'L� 1-L D, 3 49 5
Legal Description: Se'5_o
Property Tax ID#: l0 I l 00 —C ^ O Lot No.
Site Plan Name: �5� C \ a Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: -
DETAILED DESCRIPTION OF WORK:
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VJe,o S sk-c vkA 6o o,Mcan 'JSYM0310 k A; Av�kk oAoc\e\ \k . �. (0C oi` 4.
[CONSTRUCTION INFORMATION:
itiona wor to, e e orme under this permit—check all apply:
HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
Electric. ❑ Plumbing ❑Sprinklers ❑Generator [] Roof
TotafSq.`Ft'of'Construction: S n-of First.Floor:
-Cost'of-Construction:$ 150.eo utilities. ewer E]septic` '- Building Height: .
OWNER/LESSEE: CONTRACTOR:
Name_. � k 5 L:
Address. Coma :�-e -()ee i r Uri sr�C.,\,-
city-
va:City. State!�I_ Addresss:5-10 - "N. u)u A Sc.c Z
Zip Code;-3� _\ : bko(I-loS-1- 3-191 a City: goq"-\ State:
Phone No. 9SN-'3"�,ek - f100 Zip Code: 33`A\` Fax: 51'r'k--1 f0—CASC
E-Mail: Phone No.fj(o\^433-�- QSY0
Fill-in fee simple Title Holder on next page(i di erent E-Mail: 1\e4
from the Owner listed above) State or County License:CP►(rJe)\105b
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: %./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 tpfirst inspection. If you intend to obtain financing, consult with lender or an attorney before
comme,n,eing work or recprding your Notice of Commencement.17,7
s
_Signature of Owner/Lessee/Agent tgnature of Contractor/License Holder
STATE OF FLOIADA STATE OF FLORIDA
COUNTY-OF Yc\w► 6e�,,L n COUNTY OF P&\V, 'pie h
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this aa'dayof 2011 by thisday of 20 lS by
h�NQS L•
(Name of person acknowledging) (Name of person acknowledging)
CANDACE E.TRIPP ?°`P'PbB`% CANDACE E.TRIPP
•. J e * MY COMMISSION#EE 854222
MY COMMISSION#EE 854222
J EXPIRES:March 27,2017
P_ * y �G
(Signature of Notary Public- `i idg-b edThruBudgetNotaryservices (Signature of Notary Public- h;'F ridJJdedThmeudgetNota�yservices
FOF F�
Personally Known `� OR-Produced Identification Personally Known L--`�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
FINITIALS