HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: ��/ 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:
PR®P®SED IY1/IPR® EMEN r LOCATI®N: 0110,11111 MAIM' IWISM 9.
Address: Oy,"/ Jei,tc'h /.�ed.c,G. Az. ?SIy__5
Legal Description: &IdIlle j Z%/rhW 1_^C. s 71Z J7,/
Property Tax ID#: 7 J�� `J��l` �J��I` ODD Lot No. /9
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�®E�TAFLE® ®E�SCRaI.�l®N�QF 1"tV0"RK• e� � �"� �� � � y�� V
'�LF' ,...��TitT .y.. i_d 3 .... ...... �;+p�"vY� �i'�'Ya��.,^.� � '..:�... STB .,,. �:-v. '.•�!t� ..{ €
Colnllefe defno/.Lich o� p-,4-/ fjornP
CONS�TR= j:kN I
itiona work toe e orme under tispermit-checka appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric ❑ Plumbing Sprinklers FIGenerator Roof
Total Sq. Ft of Construction`: y�� Sq. Ft. of First Floor: y�b
Cost of Construction:$ /70Q,oo Utilities: Sewer Septic Building Height:
QAWNERLESSEE ° } C®NTRAC1'OR� M
N .,£3�s..-4/..3.
Name 7,0je 4. d- Z4 Name: ` m
Address: r.tS'�!"`�/ Gy! Company: cyn � rl' ��C�Sr -�i✓�. ire.
City: !'�i rami State:jft� Address: /ff177�E
Zip Code: 3 U
/ 77 Fax: rr�� City: Jenre� eic! State: IF&
Phone No. 305-' 97 9 s 3�7� Zip Code: 3Y97 Fax: 7Z2 ;-3a
E-Mail: Phone No. 77,7- -2-X0 -371§__
Fill in fee simple Title Holder on next page(if different E-Mail: d W1247.51"%T/ %il C (LD >W/W 0 -C oar,
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU PLEM�ENTAL.CO.NSTRt1..Cfl®N HIEN L.AU1/ I'N ORMATI®. .
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 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 worJ9or recording-tour Notice of Commencement.
s
_Sig ature of Owner" Lessee/Agent Signature of Contractor/ ' Holder
STATE OF FLORIDA ` — STATE OF FLORIDA /
COUNTY OF ,�—��t �C� COUNTY OF
The r oing instrurueot waslacklnowledged before me The foLgoing instr ment w acknowledge ore me
this day of J �Jv\ 201'Sby this day of 20 by
AMlc�dy\ �M
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of No ry Public-State of Florida)
Pers zglfti _n d ti ication Pe w OR Produced Identification
Typ ° • ti% q��F� HUFF :Typ o �;lq�ertifica i
•. - ° o- .tate of Florida �•� Notary N�EtA M HUfF
Commission#FF 23473(Sea Cominissl'o '€Vo. y FuD. .State of Florida Seal)
Comtni ;;,,.,`a Ron n—- ,rPr►�s May 27.2019 r;omm n#FF 234730
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NationalN-H.7ry• ExpiresA"%77
Revised 07/15/2014 - -�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS