HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! Permit Number:
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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
PRC3POSED lMPROVENIENT L'OCATIC►N " E s3 i j
Address: Q 0160 _S 0(!_i5,4 AJ -
Legal Description: 1379141E M A P
PAAdeL iQ qS la -- 70 2 _ 00/,5- - 04)0 -- '7 C2 1-793 -W5
Property Tax ID#: :P..Lf 0/ JL 2 Lot No.
Site Plan Name: C)C i AA) QUA))eS e QA) 0Q"1�A-)fu X4 4� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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COtVSTRi1CT10N`INF,ORMATION = ,' ngs
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Ad,clipional work toe e orme un er this permit—check a appy:
HVAC E3 Gas Tank Gas Piping _Shutters Windows/Doors
13 Electric 0 Plumbing Sprinklers D Generator Roof
Total Sq. Ft of Construction: 1 r SQ.Ft.of First Floor:
Cost of Construction:$ c�6�C'/ p� Utilities:O Sewer Septic Building Height:
OWIU'ERjLESSEE 4
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Name^ Lt 1L(J -f,�, C A11,4AJ Name: lP A L /UO
Address: l b 9 9U S()CQ"- DR _47 Lily Company: M A KV K_ L F 4/-;y 1� c
City: 13a&14 State: r--L Address: 11 q _� 56 L. ( k-A L-AI 6-
Zip Code:3 4 Cl S Fax: r__ City: -PCXR t-'37', U L L('� State:�1-t
Phone No. 1�- �-c�- — �'j'3 �f'2 �! Zip Code:3 V-q Fax:
E-Mail: Phone No. ' l� �?- U -7:�
Fill in fee simple Title Holder on next page(if different E-Mail: yA L P 6 fa(�
from the Owner listed above) State or County License: C 1 t l a L
If Value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
�5.1}RP t�MyEN A�.�CUNSTRUCTiQN,LiEN lAW INi=�RMATIQN•;� � �; :,Y " � � � � � �' � '
DESIGNER/ENGINEER: _,_,_Not Applicable r MORTGAGE COMPANY• Not Applicable
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 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 Horne 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,wails,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 our Notice of Commencement.
_Signature of Owner/Lessee/Agent Signature of Contra�cttorr//License Holder
STATE OF FLORID _ STATE OF FLORID ~`
COUNTY OFA, .COUNTY OF
The f oing Inst u en as acknowledg fore me The fo ing ins men as acknowledgerby re me
this day of 20by this day of 207
'— ML �
(Name of person ackn wedging) (Name of person acknow a Ing)
Ci'
(Signature of Notary Public-State of Flori ) (Signature of Notary Public-State of Flor }
Personally Known gat mouced Iden(y(tt=iMtLONE ersonally Known n� �MILONE r
Type of Identification Pr c( ' " "°e1'a Rr$'a'�olgayced ident(F' t7 i
ype of Identification Pr .`� Notary uo - ate-ttt-F4--Ia
*•_My Comm.Expires Mar 22,201 _•; .•:My�omm. 17
Commission No. =�• 'o�c &Msslon#EE 877571 ommission No. ;�* `�� C Ian# E 877571
Bonded Through National NotaryAs . nF1
'',�oF.v s Bonded Through Natio at Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE REVIEW
COMPLETE f
INITIALS !.
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