HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: JS Permit Number: �y�P
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 V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
U.S. z
Legal Description: f l .- l -4 N V i<-r'A fz>SSI rvc, �-21212Ca Q +CX_
Property Tax ID#: . 75_9660 _D6^� D- Lot No.
Site Plan Name: —PLt mc- Vt STFt a J Ess t n: Block No.
Project Name: Y VVV.,_ Ut Q_V SS
Setbacks Front Back: Right ide: Left Side:
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r4+..C} ISTRUCTlQNIN'.�fJR)VfQTICINIr _E
diitioona war to be���er orme under this permit-c ec k all tftat appy:
�HVAC LJ Gas Tank QGas Piping _Shutters Q Windows/Doors
oElectric F�Plumbing Sprinklers 0 Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ S.�6t .ob Utilities'n Sewer Q Septic Building Height:
s
Name t-n Sir „et 6)sst rt41 ). L Name: Ml
Address: 0-10 Cx>vnrr+eY-(?A C l Company: f*lbr`i u P P J-� (i;�O
o c3ur ,�� Address: 1-LCK xt' uTti
Citya �w.ct a tate
Zip Cade: '33'F Fax: �2LI 343- t lO b` City Rim ���"i�o'r'5 State: rt,
Phone No. 5-J&I-•34-1 --0 1R�19s( Zip Code: 73 tf its Fax:
E-Mail r r) 'r - 5--Ce vt{Lv'S.C� Phone No. SSI - t�1`J-t t v
Fill in fee simpil Title Holder on next page(if different E-Mail: h);C t'dt�t-� L QFAA l' 6011-,
from the Owner listed-above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SLIPPLEMENTAC Cf3NSTRUCTlON LlERI 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: TNot Applicable
Name- pv�. Pki Mo, Name:
Address: K) Q& -Ar, "' lL Address:
City: 141 City.
Zip: Phone: _r, 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.
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_signature of Owner/Lessee A 4-R C R-&7,t,Clleir P,,,SSignature of Contras or/License Holder
STATE OF FLO STATE OF FLORIDA
COUNTY OF a_I m k V&,-[, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1-4 day of Z w�a_ 201-:5'by this�day of 20 IS by
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Ma rc j A .
(Name person acknowledging) (Name of person acknowledging)
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(signature of Notary Public-State of Florida} tgn ture of Notary Public- tate of Florida}
Personally Known ✓' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Pr �" Type of Identification Produced
DEB51t:L.Cf Rt'1
Commission No. NOTARY PUBLIC=S ATE OF FLORIDA Commission� brit. �a a(o3 (Seal) M
1SSfONRS 4S?207
0!2017 '�A
MY COMMISSION EXP t
PuP,,, 4�n1ar y �P'es 1112
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION J.SEATURTLE•�--="MANGROVE
COUNTER ( REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE I
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