HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: —j S Permit Number: I 67
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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
PROPOSED 111/IP OUEMENT�LOCA�I�ON
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Address: Qyezh A-we-
Legal Description: /
Property Tax ID#: ������®��(��� C3p(�I r $ Lot No.
Site Plan Name: 1 Block No.
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Project Name: i, 40011
Setbacks Front_ Back: d Right Side: Left Side: �D
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Additional work to be pertormed under this permit—check a appy:
HVAC Gas Tank ®Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers FtQLenerator 1:1 Roof
Total Sq. Ft of Construction:1116
CS Ft. of First Floor:
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Cost of Construction:$ p 166� Utilities: _Sewer Septic Building Height:
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01NN„ER/LESSEE s; CONTR}ACTOR ”
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Name 0ZX/Uii61Name:.,' 12W. ✓`" P -ell e-K
Address: /A' 0Oeer! /4?ne Company'.;` r100erk Gas X�J eSs
City: m►'�d/��%e�� State: Address:: _�1�"}`� S' ii��eY
Zip Code: 3"19T 1 Fax: City: S/vas'fi tate: 1L
Phone No. zip Code: 3y9q`f Fax: 79/—//,9,5
E-Mail: Phone No. 7 V/—//97
Fill in fee simple Title Holder on next page(if different E-Mail: 922:�t (" co y►I
from the Owner listed" above) State or County License: }(o 57/5—
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPEXI1/IENT�L'CONSTRClNENLAWI�NOf2MA
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TIT E HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: OeLo(f Name:
Address: uoen e Address:
City: City:
Zip: Phone: 5— 1611Z 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 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 lende or an at ey before
commencin work or rec in r otice of Commencement.
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_Signature f Owner/Lessee/Agent Signatur ,of Contractor/License Holder
STATE 0 FLORIDAd STAT OF FLORID
COUNTY OF t COU TY OF_�
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The for oing_ins ment was acknowledgedh.efore me The forgoing inst ent was acknowledged before me
this day of 20 j�by this day of 20 [5-,by
TNab,
of person acknowledging (Name o erson acknowledgi g
a ure of Notary Public- a of Flori (Signature of Notary Public- tate of Florida)
Personally Known ORP oducP P rs n ly Known ---OR Identification
Type of Identification Produced DAWN MILON.Type o dentification Pr duced_
Notary Public-State t Florida
Commission No. + 5 3� Y Comm.Expires MaoNTurrpi Sion No. e
Commission EE 77571 : •* ;��= Notar N MILONE
.0, State Bonded Throw h National otar Assn. �,± • ' M Y Public'State o!
OF F,oa Co res Mar 22;2017
Revised 07/15/2014 "" Bondedmmission 571
Throw ti EE 877
9h National Notary As
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION: SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS