HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INTj US�CO LETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: � l0
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"IIVIRROVEMENT LOCATIQN =
Address: 7T-6 S Dix^{-n1 �:J£N�t /� l� 3L4
C-1 n
Legal Description: J Sl /I� UJN�S r4WO /`7' IJIVIT
ADMIA" Z eAA40 Lo R?- �2 2 T" 7s f
Property Tax ID#: ,3S '? -601 - Q!57UO-OGb Lot No.
Site Plan Name: 13EL-C.t4'rr11.i Block No.
Project Name: Ezc +✓
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION t7F WORK '
CfJNSTRUCTIgN INyFOR IUI/-tTION
Additional work toe e orme under this permit-check a appy: `
❑HVAC E]Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ��1� Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name OL I67 ,-� " Name: rcyl L W/
Address: 87r S 0ceg,,J /:/✓[, 1y3Y Company: T&Vtnl
C /SCAc.I�i GLt?ti��vwR1
� N
"City: 'rLrI�,L C,�f-�JG y State: /�i Address:� Z� C✓ F�� #it`e
ZiipCode: iY�l -J Fax: City: �11�i'Z.� State: '��
Phone No. Zip Code: 3NJ!qT Fax: (Df 2 ?Yy
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: A4tc.ihyy(_c, �zrD/kWi'via V` 16h.r_o!M
from the Owner listed above) State or County License: CSP./'mica 27
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CC3NSTRUCTIO.N UEC LAIN INEORMATI4N
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 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:Yoe
o failure to Record a Notice of Commencement may result in your paying twice for
improvements to your pr per A Notice of Commencement must be recorded nd post d on the jobsite
befor a f' st inspecti n. I u intend to obtain financing, co t%A lend or a rney before
co men ' wor or cor our Notice of Commencem
A(tT•�r�1z� /
s
_Signature of Owner/Le e/ gent ignatu a of Contractor/Li a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,.S i COUNTY OF -S/—
The
STThe forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,�6h of �tl/�� 20j,5-by this/5"tiay of �[��� 2015 Eby
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of_N otary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identificat' -
S` r'ry' ANN M.GAUMOND
Commission No. '� r' AN MOND 14' MY COMMISSILP�i)73907
��tON Commission No. _.: .: 7
MY COM 9 FF 173907 :s., :g: IRES:December 2018
7 A= EXPIRES;December 7,2018 Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS