HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -7-2-7 - 1 5- Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential
a
PERMIT APPLICATION FOR: .
MRaPaSED IMPR�VEMENI'L®CATnnL®N:
Address: 107.25- B n U/. y J��ren mac% Z. 3V S 7
Legal Description: v at `v i e 677.e,
Property Tax ID#: I/j-//- 000O - 00(/ ' Lot No. Z/
Site Plan Name: Q, Block No. 151
Project Name: 60t y
Setbacks Front Back: Right Side: Left Side:
�D'ETrAI�ED D�E�SCR�I�TION' 0� WORD •
che/ ,�-e^ova / 0 7' Y9� S v�a��/ kpie
�/✓!G>' ��4P�u Q l�'DD 1311
CO�VSTRUCTlQN I �FORMATI®N:
Additional work to be performed
. under this permit—check all appy:
E1HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: V/G Sq. Ft.of First Floor: 4/76
Cost of Construction:$ 1-7-Mve Utilities: Sewer Septic Building Height: �i t
01NN'ER/ : 1101
CONI"RAt"f®R:
Name)9e,e S" >.� ' r�:� Q,r,�Yf �4�1��. Name:
Address: 30/ t�f� . �i:.. Company: WaL
City: P 04 eel State:4E// Address:
Zip Code: V35hV Fax: City: .._...:.:..,_:..'.:::.-....... •: -
State:/'C/'—
Phone No. 772 3V- 0/// Zip Code: .3 Y95'7- Fax: 77.2 232 1l9/
E-Mail: Phone No. —1'72 -.2,0 - .37/.5
Fill in fee simple Title Holder on next page(if different E-Mail: a-A, '-d G (0�4/D0 -co-m
from the Owner listed above) State or County License: Cmc_ /.-F//r�'/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sl1P'Pl�EMENT,�L C®.NrS�TR;U� �ION�LI'EN L�IW INFQRMATI®N�;
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 work or ecordin Notice of Commencement.
s
_Signature of Owner/Lessee Agent Signature of Contractor icense Holder
STATE OF FLORIDA STATE OF FLORIDA /
COUNTY OF
Q.
/ _u,CIe_ COUNTY OF
The for oing instr t was`acknowledged b ore me The for oing instrument was acknowledged ore me
this Jay of \ 20I Sby this��ay of 20 1__� by
A Aa ij:��
(Name of person acknowledging) (Name of erson acknowledging.a"—� )Y� UJ — a"'�
)
(Signature of taryPublic- a of Florida) (Signature of Nota( Public-Sta Florida)
Personally Known- OIR awib tification PersonallynQhN
OR Atificati
Type of Ide(tti#ication Pf494 �4Jt8d�1 HUFF Type of Id 11'-a Public-State of Florida
Notary Public-State ofI
•« Comm ss on
-"� «� My Comm.Expires M 019
Comm,C' •' Commission�FF 23I) Commissi � , o° p a�
Comm. xpires ay gh National otary ssn.
Bonded through National
No
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS