HomeMy WebLinkAboutBuilding Permit Application 9
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: K,� %C\ 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
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Address:1O/2 �o��a��g All. El <3 y9YX
Legal Description: d✓C 3 6-7 G " .2-2 6 Z 1
Property Tax ID#: 3 y/'O — 30.3 o O 7-:7 oz - 000 0i Lot No.3_
Site Plan Name: Block No.
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Project Name: f/a0�'!�✓oo+
Setbacks Front Back:�_Right Side: Left Side:
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CC+NSTRUCT(C►� �FURMA�1"ON
Additionalwork to be nertormed under tispermit—c ec .a apply:
HVAC Gas Tank ❑Gas Piping LAJ Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers El Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
vV
Cost of Construction:$ � (7 Utilities: _Sewer E]Septic Building Height: O `�'
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C)WER�/£LESSE3 NTRAGTOR �, g �� ;Y
rf r"`�
'Name ._,47a, 4 i . �._ AM S flv► Name: a
1..
Address:.:, O ,2 ,0 ,` Company: Dr.,J nP.// d F
City! RT IC pec State: I Address: 42a6 'e
Zip Code: 3 c/9 J0.2 Fax: City: do� /Of e.,—& [ State: P/
Phone No. 402— 913 Zip Code: 081VFax: 772•
E-Mail: Phone No. — 02 -�
Fill in fee simple Title Holder on next page (if different E-Mail: rO .c x,& b J L P
from the Owner listed above) State or County License*,S4e4 3 d/tom
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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StIP' EM�NTj.CONST=RIOT C}N [j�1 'N"LA1N�IN1=` RNJAtON� . w3 � "xF ; s.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 14 Name:
Address: Z ID Address: 14Z_
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 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 o Notice of Commencement.
(ignature of Owner/Agent/Lessee Signature of Cohtra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'S k, 1_p c \e COUNTY OF S -� � \.\1 c.'2
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \d\ day of U 20 L9 by this day ofy U YyA 20_\6 by
� harr.� 5 SkUb� c �1naw..dls ��►� bt �
(Name of person acknowledging) (Name of person acknowledging)
(Signature,of Notary Pub c-State of Florida) (Signature of Notary Pub ic-State of Florida)
Personally Known OR Produced Iden ' on as Personally Known OR Produced Ideratifi�� �fi�ENs
Type of IdentificationProduced t. G�� .o,F� o� Type of Identification'Produced EX-'fl�
DSP
Commission•No. Commission No. =FX ,,,..8�, No�a�Y ExP��es EE858��pssd.
- J�a_ Com�coU9hNauona
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS