HomeMy WebLinkAboutBuilding Permit Application ALL APPLIIC/CAA�B E INFOUST COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: LI/ �JJ Permit Number:
1
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
.Phone: (772)4,62-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
:PROPOSED II\lIPR01/EMElUT
Address: IO8bo S r2c JE 101 Zo l 301 1401 5-01 smixt
Legal Description: rJO0 - AJ rf - /Li - zo d 'U1111-r5 / -1
A?y0 rrs uooi✓ s chine Dr- rdrkA oti a /�44 /I�2 �ttrrr, haw T2rxF
Property Tax ID#: Loco —CC 7 Lot No.
Site Plan Name: -7-oa g A8-p Block No.
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Project Name: Av(?Jr1rEs� �T
Setbacks Front !Q Back: ti A Right Side:��Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION ' '
y
�Additional work to be nertormecl under this permit-check all apply:
❑HVAC Gas Tank Gas Piping M_Shutters Windows/Doors
Electric ❑Plumbing Sprinklers ❑Generator _Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ��,�O Utilities:Sewer O Septic Building Height:
CONTRACTOR w < ,
�. . . ...K
Name 2 oti4 Name: 1Y1C11bftL Wit
Address: 108007 )CL-Al�j �2& Company:
City: �'r71(f�Tl oenc.f>! State: RZ' Address: M AW
Zip Code:_ 3YJJ(_'7 Fax: City: S_A14itT State: Et—
Phone No. 1772 Zip Code: WfQe Fax: G44 7YY
E-Mail: Phone-No. &f 2! -001,0
Fill in fee simple Title Holder on next page(if different E-Mail:/ 144141 ZL (po06y1w C "r-7
from the Owner listed above) State or County License: CSG n-0,3
,3 Y 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIQN
.. .. d
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:Your failure to ecord a Notice of Commencement may result in ur pa ' g twice for
improvements to your prope tice of Commencement must be recorded a po on the jobsite
before the first in ect' i end to obtain financing, consult with I d r a a orney before
co en ' r it d' r Notice of Commencem
V C6 s
_Signature of Owner/Les a/Agent Sign ture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 57— h 1)G/,,C COUNTY OF S7!
The forgoi g instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 50%y of 3C,/I�f- 20/5 by this/jy ay of �(>/1JF 20/�by
(Name of person acknowledging) (Name of person acknowledging)
(Sign 6-of Notary Public-State of Florida) (Signature oIVotary Public-State of Florida)
Personally Known /_OR Produced Identification Personally Known - *" OR Produced Identification
Type of Identification Produced Type of Identification Produced
r �iv,' ANN M„GNU OND ,�"
Commission No. ,• X41 Commission ,•'�ti�P''• ANN M.GAUMOi(Seal)
;f—MY COMMI FF 173907 MY WMISSION S FF 173907
EXPIRES:December 7,2018 g: a EXPIRES:December 7,2018
Bonded Thor Nota Public Underwriters ^'•..
Public Ur;dergd*rs7
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS