HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: b '" 15 Permit Number: +.
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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
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P.ROPOSED-,;l PROVE_1 lEi l LOC Tt®N:
Address: 4-703 SZ m3iiN
Legal Description:' - 440 �_: I-(4 f�f if bi 23( E-J I LIQ? PA-
4 5; 4 Olt,
Property Tax ID#: 3l0 `o Lot No.
Site Plan Name: Block No.
Project Name:
r
Setbacks Front 7 501 Back: S(? Right Side:_31 _Left Side: NIA
DETAILED DESCRIPTION ®F,111lORK: _ iU
CONSTRUCTION lNFORiVlATION:
Additional work to (e oe orme under this permit-check a appy:
HVAC (_J Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
1-1 Electric 0 Plumbing Sprinklers FIGenerator F] Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
0
Cost of Construction:$ Utilities: _Sewer F]Septic Building Height:
WN' LESSEE y CO;NTFtA 7OR
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Name �gi fNz ed- f�_ Name:
Address:`' 15�. -'-v\ - Company:
City:- iQ State: Address:
Zip Code:Nil 31 Fax: -- City: State:
Phone No. ? � 'Q Zip Cade: Fax:
E-Mail: ' 'Ir"S s S i11,1Gu CeM Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCTfC)fU LEEN' LAW EINFQE2MA1'EN. _
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name:VkCS � C. Cz 4W., ^t r^;dr TA c, Name:
Address: Wgtkgo,S SyZV J0160Address:
City: tti A Stater City: State:
Zip-13,0011Phone: 4407- �- . 3 3 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 thepermit 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.
s
nature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF IskCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisL day of 20 ICby this,day of 20 _by
(Name of person acknowledging} (Name of person acknowledging}
1gn)g
ture of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification```s Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
t�D as&It S.LDS-10S•0
Commission No. (Seall mission No. (Seal)
LASHANNA'IN�RAM
of FI Ida
Revised 07/15/2014
o'`,-` My Comm.Expires Dec 20,201
. ' Commission#FF 177249
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REVIEWS FRONT KING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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