HomeMy WebLinkAboutBuilding Permit Application `ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 IMPRG' EMENTT-LOCATION. . h
Address: 1/.S1 cy, lr,2 '-Z- /S-� Y c/,,,NCl-eSZ i-Vd A,If 11-k M p 7�/C-
Legal Description: 3 _311 6 o S (o SO
"moo
u5 So Vc,,.,,A- of N "10 AC S. 1Z1-76$ -ao-1�i
Property Tax ID#: 1_30 '-'l00-11 -d o o-/ Lot No.
Site Plan Name: NC M IS �`l��-�� Block No.
Project Name: life/V1 (7 Z 5A,Q
Setbacks Front Back: /�' Right Side: SL Left Side: /S._ c77.)/-T-
DETAILED DESCRIPTION OF WORK
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60/1 e- /Cf >c / a f��C ' 7=/9 03 S CJ r e// u YAZ ✓�
CONSTRUCTI'ON-I% N FORMATION
itional work tob.enerformedunder this permit-check all appy:
UHVAC Gas Tan LIGas Piping _ utters Windows/Doors
Electric Plumbin r' klers Generator Roof
Total Sq. Ft of Co ion: S . Ft.of First Floor:
00
Cos onstruction: $ oo, Utilities: Sewer Septic Building Height:
OWNER/L-ESSE'E
CONTRACTOR:'.,
Name �'Aa2�/t/e� i i z ' Name: n
Address: S/ 0i�r �S'6 Company:
City: Fe-_- p4elzcl e State:LC Address: ( 17 (l C, I
Zip Code: �ITII C Fax: /7 G3 City: i rce State:-t- I
Phone No. -7),A? Zip Code: L Fax: Y7
E-Mail: ?jam Phone No. `7 7 Z - ?�Z 9
Fill in fee simple Title Holder on next page(if different E-Mail: S1 46D TIL r t"a Lk, CL11 Qa.C611
from the Owner listed above) State or County License: �.�C Z S S Z
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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S1JOt''MENTA-LyCONSTRU#IbN LIEN tAW 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: Phon
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.
i nature of r/Agent/Lessee =TATE
e of Cont c r/License Holder
STATE O LOFF IDA
COON OF L/1� LUCI e? COUNTY O cUn-f La e,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of . 20 14 by this day of 20_jA by
::Ln
(Name of perso a n wledging) (Name of person ac n wl dging)
/_\ - - i
k .
(Signaturef t ubli - tate of Florida) (Signature o Not Pu ic-S` of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
TIFFANY S.NIXON .
Commission No.�LC 57 O&ARYPUBLIC Commission No. (ANY S.NIXON
STATE OF FLORIDA NOTARY PUBLIC
1-m-4 EE834M STATE OF FLORIDA
Revised 07/15/2014 Explres 10/1/2016 Comm#EEB34576
Expires 1011116
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS