HomeMy WebLinkAboutBuilding Permit Application ALL APPLICg�AB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �}
Date: _f� - Permit Number,
ILA A
zm
Building Permit Application
Planning and Development Services
Bui;ding and Code Reala?otinn Division'3ftt}Vir"i is revenue, Fort Pierce FL 341982
Phone: (772),162-1553 Fax: (772)x:62-1579 Commercial Residential
PERMIT APPLICATION FOR To Select from dropboxclick arrow at the end of line-[2 jf7l�fl ?7 �7 I1+ ( ?tlLt�r 4�1; IOC TIC71�€
Address:
Legal Description: px_V c.1.'.)
Property Tax;D It: %C) .' t:aC)oy, - i��C, _ ___ __ Lot Idi,
Lite Plan Platte: #AU1 �t'�____� t-` _ � _ _ _ _t E s�tr ! 131oci;I'+'J.
Project.Name: -
Setbacks Front Back:� Right Side: Left Side:
rr f�ETAIL1�l� 13ESCRlPTI0�4 OF 1lVC}f?1� ` ,, �,
CONT.,R0CT10N INE0RMATION
�t(iiirfiroilal wcirl,to""'l ei Fortile`eel rode this ac�i►iiit-cries all �a- r.
? i IVAC 11 Gas Tank Gas:'i^ing ��' Shuttnr:, �Ltfindr���sJl3oars
((�� t
�Electric �Plumbing 1:1 Sprinklers L_1 Generator i; Roof
Ft.of First Floor:
c�
Cast of Construction: $ Utilities: ___Se ver[l septic Building Height:
Oli�IIE(i{ - SE ( , �r # Ci1T< —,-C ft.
Name.IkA t i rt,LQ j \ I� l z � S r� Z \ )
_ _ ar le j4
Addressjt:xj ` -V: { Company: �� a ti` `{ f.• �� f , � w;� __
City: t . i t i l C_ State:0_ (� Address:
I Zip Coder LI'lFax: City: C.t'7 stater . I
i Phone Ploy I Q �-t_(�� ���di i �'• �, C} r ;
% Zip Code, �+�. �r' rax: €
E-Mail:_ Ztr2T 13 itit tAr-II_
Flll in fee simple Title Holder on next page{if different E-mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement ic.required.
�i.�:��L�i�rl�i�jT�L CdNSTRUCTt�I� Lilrf�a Li�1r�1lt�li-C�f�N]�TIO��t _
DESIGNER/ENGINEER: Not Applicable � �!�MORTGAGE COMPANY: Not Applicable
, I
I (Name: _ i Name:_ _ ----------
j Address: _ _ j Address:wAw
City: State: City: State:—
Zip: Phone: -- — zip:
FEE SiMPLE TITLE HOLDER: r Not Applicable } BONDING COMPANY: _Not Applicable
Name:
Address:
--_ ---- —
! (Name:. i N
- - ------ - - — I --
i Address: _ ; Address:
City:
Lip: Phone: _._._..._._._._.—_� SII):
I certify that no:'fork or installation has commenced priur to the issuance of a permit_
St.Lucie County makes no representation that is grantir;g a Pe!rrnit will atahorize the permit hokfer to bUf!d the subject structure
.vhich is in convict with any applicable Home Owners Assorration rules,bylaws or and covenants that n:ay restrict or prohibit such
structure.Please consult vv,th your Home Owners Association and review your-deed for any restrictions which lrw 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 i)ermit apf,lications are exempt from undergoing a full concurrency review:room additions,
carces5or)t_tructures.Sv-fimming pools.fences,vialls,signs.Scram rooms and accessory,uses to mother non-residcrItial use_
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
itnprovetnents 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 leader or an attorney before
commencinv.wort;or recordinl;vour Notice of Commencement.
Signaturgg, O"ane P/llf cntf t r ce i Signature of Contractor/License!loll
STATE OF r+9f�M8-A(1)"5Con5iA ( STATE OF FLORIDA ,
j COUNTY OF OG,.n es�►u couNTY o1 3r tin _•�_y:r _
i —
The Torg ing instrument,.as acknowledged before me , The t oing urstr anent way acknowledged before me ,
thisa day of :y / ,•2d_ i�: i ibis day of ___ 'J_i5by s
1 f
(tdame of person acknowledging) i (Marne of person acknovAedgingLAX
5
l
--- - I
(Signature of Notary Public-Stale ofd) 11 {SwatUreotary Public-State of Florida)
Personally Known QR RrojWced I er ifiratLon .X _ i Personally Known__._._ _0R Produced 1.dentific:rt'ion _
Type of Identification Pr ucedwx air ___.� ___.___ i T e of Identification Produced—-
SAMUEL
roduced_ -SAMUEL HENpRICKS
Commission No. i Public l r n;rnission' mea ;
SPa��VB� ELIZABETH EVANS C
state of Wisconsin ' r�.
Notacy_ ublic-:State of Florida
:oma;My Comm.ExPlres:Mat 19,.2016 --�
B,evi.ed 0i/15/201;1 ..",;eoc��o::' Commission#r EE 180957
n.nna
REVIEWS I FRONT ZONING I SUPERVISOR PLANS VEGETATION [SEA TURTLE NIaNGRQVE
1 COUNTER4 REVIEW I REVIEW RE-VIEW REVIEW � REVIEIN REVIEW
DATE
COMPLETE
f
! ImlTiAL S