HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7-79- ✓G Permit Number:
rc-IMMI ON
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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
'PROP.OSED'IMRROVEM,ENT LO.CATLO.N:
Address: `7005 ane -VL Eva , r-L �14951
Legal Description: LG CWC)60 11 el-V, 15-0 Le j°( �MGe 13/J2-N) or
X3`72.1 --lbS/b ; 3-762_-126_0
Property Tax ID#: 3 I�-' d J � Lot No.
Site Plan Name: Block No. It�0
Project Name:
Setbacks Front Back: Right Side: Left Side:
'D,ET'AItLED�DE',SCR'IPTIO:N�OF WORK:
CONSTR,UCTI,O"N 'IN.FORMATIO-N
Additional work to be Dertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
❑Electric ..0-Plumbing ❑SprinklersGenerator Roof
Total Sq. Ft of.Construction:. S . Ft.of First FI'oor:
Cost of Construction:$ �- Utilities: Sewer❑Septic Building Height:
OWN E'R/LESS',E;E: CONTRACTOR:
Name�<gar; d moan. 14, c4sed �o�n. 14, c4se Name: PAUL SAMPSON
Address:7ad5 C�h�inti Lh. Company:TLC EXPERTS
City: F� I ;912rriL State: `L Address: 1237 DELAWARE AVE.
Zip Code: 3 4'15- 1 Fax: City: FT. PIERCE State:FL
Phone No.�-7 2-'I 2'1 --�`i l I Zip Code: 34950 Fax: 772-466-1655
E-Mail: Phone No. 772-466-7626
Fill in fee simple Title Holder on next page(if different E-Mail: keith@ticexperts.com
from the Owner listed above) State or County License: CBC1258197
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION' LIEN LAW INFORMATION:
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 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 work2gr recording our Notice of Commencement.
s
ignatu a of Owner/Lessee/Agent Signature of Contrac or/Lic se Holder
STATE OF FLOR LU(�,Q STATE OF FLO j u . e_
COUNTY OF C. COUNTY OF lrl�1CI
The f Inst r en cknowledge fore me The f r i g instr me t was acknowledged b fore me
this_day of 20 VDby this '1'day of 20 acknowledged
POLU IA"w
(Name of person ack edging) ��oA Jay iej��r� (Na a of person ac owl ging) ,OA
s��ISSIO�y•s������� `�Q,P'�95�0.1EXP�9• //`�
y�'e,Mber1�Ffo�•. :0 2p Fs•� Z
(Signature of Nota��OR
tat aYida _ ( i ure of tary P c-_ a• Iori�J, o
♦.� — • ._,
o O• 1636 •¢-,:
Personally Known Pro 'I (e RRfilbn : s Personally Known C rgduceYi9+ n fi
Type of Identification Produced •'� �0'+d�dmm•�T Type of Identification ProduceM •• eona�
••TATE F` �ti P �(P.
Commission No. 1 �V^ f�'ca� �,,.,;>��. �' Commission No. ' ���5a1)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS