HomeMy WebLinkAboutBuilding Permit Application ALL APPLIn�.E Ng MU BE QCIMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
-
n-}y. t' =. % Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 ;f
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential VV
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:91, D &PAaee j, R,^ /��3, `z_eh S-eti _ffernk 4 6- J�yS'Y
Legal Description: I,, Ci(.0 is 0—cec1 lr` 1 Cl j l.L(� �1 ' i 1033 A k
Property Tax ID#: Lot No.
Site Plan Name: :Tho nLu)2aQ Block No.
Project Name: T[Alf'r Rpsqickwo
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e P 10- ag 1.0-S Lo
Impo�- •
CONSTRUCTION INFORMATION:
�Add it!onal work to be oertormed under this eerm!t—c. ec. a . ;_a apn.y:
11HVAC LJ Gas Tank []Gas Piping U Shutters FN Windows/Doors
❑Electric ❑ Plumbing El Sprinklers Generator Roof
Total Sq. Ft of Construction: ��-2 Sq- Ft. of First Floor:
Cost of Construction: $�, .( Utilities:[]Sewer E Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name SA , �� i Name: aid tp'P03d_e
Address: 19 ("O PSib L1, s7 Lanfl Company: -Th GICtSS PrQk�SS) S
City: State: ME ! Address: Q7� 1>>X P A "VLA
Zip Code: (14n ax: City: 'IOLY State:_FL
Phone No. -]"]a . � (}(n� I Zip Code: -�Q, Fax: -I�d -cZ •04101
E-Mail: Dna& iQ:b0 If)Cf_ Phone No.
!
Fill in fee simple Title Holder on next page ( if different j E-Mail: rY�➢ Q1(14S�rQS � (te eC�6)
from the Owner listed above) State or County License: �e��} 11�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
V
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: t/ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: j Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
i
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 (ender orAn attorney before
commencing work or recording our Notice of Commencement.
c 9/ s
_Ygnature of Owner/Lessee/Age Signatur C motor cense'Hoider
STATE OF FLOU
Al CLI STATE OF FLORIDA
COUNTY OF t !Yl.b�,t-1 COUNTY OF
1
The f rg�g instru' ent was acknowledged efore me The forgoing instru ent was acknowledgedd before me
this day ofp 20 by this day of �, 20 by 3
(Name f person acknowl ing) (Name of person acknowledging}
(Signature of Not r ublic-State of iorida } (Signature of Notary7OR
ate of Florida }
i
Personally Know OR Produced Id tification Personally Knawn Produced Identification
Type of identification Produced I Type of Identification Produced
Commission No. �._.I.sgal) _.._�._ Commission No.1F ""_• "' EIITH FROCK
WHITNEY L. BICKFORD " ice: MY COMMISSION#FF165768
-- �'' fJf4'IRES October 5;29i
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Revised 07/15/ '20 1 MY Coma-o
mission Expires (407)39"l 53 FioridallotaryService.com
December 24,2021
REVIEWS I FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
' COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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DATE �- ----- ------.—__ � -- -
COMPLETE I I
INITIALS {{