HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r� �G Permit Dumber:
0
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
-PROPOSED,IM.PkVEMENT LOCATION:
Address: k;-) JE-;..;T i- (Li)
"legal Description:-- - - - -- -- - —— -- --
Property Tax ID#: 1 1 1 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION_OF'WORK:.
qe,�� 65L,5;7'� � ��' �-y ro c t� �/.� i� � 'r Del o 1".5
=_CQ�STRUCTION_41\117_011MATION:ereitiona workto e omunder
this permit-check-a appy:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers ElGenerator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ ���. ,r¢!9 Utilities:DSewer ElSeptic Building Height:
4 WNERAESSEE: CONTRACTOR:
IL
Name C� C)Agr J� Name: eu?Ot%
Address: �� \ 4f� as I "r$a?4#V_'o Company /i t1a�) 50ca mAi .&"z
City: �-,�;•} r4 G cr? t State: rL Address: ,� est -eCW e_'G I =
Zip Code: �+ ` l Fax: city: dJ6?�� 1 ?dd� State:
Phone No. Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: " °IST ftldF
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPEEMENT'Al.�tr�1N TR lC '1 1�! Et N 1,AW INfOR /1ATIQN: f
DESIGNER/ENGINEER: w, '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 Homelowners 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.AjNotice 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
commencingwork or recordingyour Notice of Commencement.
.01 s
_Signature of Owner/Lessee/Agent Signature C n ractor/lacense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrent as acknowledged before me
this day of 20( by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Florida)
Personally Known OR Produced ldenti Personally Known OR Produced I ntification
Type of identification Produced a.>>i��i4Sfii'Rr,J rfiT, Type of identification Produced
� o ' 'Q`r�s
Commission No. � >' �gissF•t f o;P ply'' Commission No. ' > (Seal)
_ #FF 4680
*Jded
•.......«••'fir tib.
REVIEWS FRONT ZONING``111111 OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW IEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
08-07-'15 06;09 FROM- T-863 P002/002 F-750
Stt I�u 1 '0 .1i>A►t
--T 'Pa J UE�i•.iAVIt� WQf MATION:
DESIGNER/ENGINEER: TNot Applicable MORTGAGE COMPANY: _Not Applttable
Name:_ „ ____ _ Name:
Address: Address:
City: State: City State'
Zip: Phone: Zip:__ - Phone::
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: +,.-,Not Applicii17101
Name: Name'--
Address: Address:
City: City'
Zip: Phone: tip: Phone:
1 certify that no work or installation has Commenced prior to the issuance of a permit.
Sc.Lucie Coursey makes no'.repr tatlon'that is granting a permit will authorize the permit holder to build the subject;stryeture
hlcb is ip�p sntllct with ann��a�ppp stable Woyr�e Owners Association rules,bylaws or and tovenants;that may restrict or p hiWtsuch
structure.lrlA�se corisult'witti" OGr W6nFe!Ownws Assooatio"nd rmlew your deed4bFaayowt4cftas wbichmay.apply- ' - -in consloeration of the granting of this re4uested permit I do hereby agree that I will,to all respects,perform the work
in accordence with the approved plans,the Fksrioa Building Codes and St.Lucie County AmendmerTts-
The following building permit applications are(tempt from undergoing a fun concurrency resew:mom additions,
accessory structures,swimming pools,fe+r=,walls,signs,screen rooms and accessory uses,fo another non-residential use
WARNING TO OWNER:Your fstlluro to Record a No0ce of Cornmencomont may result in your paying twice for
improvements to your property.A;Notice of Commencement must be recorded and posted on the jobsife
before the first inspection.If you intend to obtain Financing,consult with lender or an attorney before
cornmencinipwgirk or recording our Notice of Commencement.
1 S
Sign of owner/Lessee/Agpn% 54gnatu actor cense Holder
STA OF FLORIDA,ks, STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing MWacknowledged before me
this en as day of 20 LJE:try
-,7)yy\yvw
(Name of person ackn ledging) (Name=of person ackno ledging)
(Signatu of Nota ublia State of Florida) P(Slkanat�urey Public-State of Florida)
P,? V r$onally Known OR Produced Wen4flrar Personally Known OR P used I tificatlon
Type of Identification Produced a�u"`� 1r �, Type of Identification Produced_!
ME
wl 0 Commission No. r (Seal)commission No. 3
4WMAHOWELLI
a EXPIRES:Sept¢rr*8,2017 i #FF 4W
`�Iry�,,, kA0�Q1Mu8u�;NoebryStrvicss O'
REVIEW5 FRONT ZONIN G R -PLANS VEGEEAMON SEA TURTLE MANGROVE
COUNTER REVIEW IEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS