HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABBL INF 1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /-S-Ty. Dal
Date: v /� Permit Numbe : I dos — C)L )�
RECEIVE®
Building Permit Application AA C
Planning and Development Services AUG 1 ZO�J
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, IMPROVEMENT LOCATION
Address: 360 E_ M\CAW0.j, 44- P I CuQ_
Legal Description:
PropertyTaxlD#:_34U'.�'502 0050p50-1 Lot No.
Site Plan Name: Block No.
Project Name: N\LCL)a..e ► C-01r1n P_Q_CA_('D
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION-O'F WORK
a
CONSTRUCTION INf.ORMATlO'N
..
Additional work to be performed under t ispermit—check all[ appy:
HVAC Gas Tank OGas Piping _Shutters Q Windows/Doors
Electric Plumbing OSprinklers Generator Roof
r
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ SOD • Oo Utilities:In Sewer Septic Building Height:
OWNER/LESSEE. -CONTRACTOR: .
Name_�b\ryg JQ Name: cQ,ek,nn n�r' rnr'6_r-1
Address: �}'lD` QkQ,nAo.,L, _ Company: R c.e5 9_\«�C—
City: p\P_�C uL State: Address:ID )'>4 Nva �t•✓\!t. Lajon 19,lve,
Zip Code:31kotg2 Fax:x"124 66 V) 4F 1 City:[ - State.EL
Phone No.` —71- BB — g 33 `+ Zip Code: Fax:
E-Mai1:�,h►n> et CA&6 C ► �r C—T)fVN Phone No. -1—CZ '`L$ 5--13$co
Fill in fee simple Title Holder on next page(if different E-Mail: Q A rv\cczv%,—
from the Owner listed above) State or County License: T'ICAP
in
of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAUV INFORMATION':
DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: �t Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _ of Applicable
Name: 1o\f\v, a ro6 Name:
Addres O Address:
City: City:
Zip: 2• Phone: Z 2 S 3 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, con A with lender or an attorney before
commencing work or recording our Notice of Commencement
A,L,. :,� s
_Signature of Owner/Lessee/Agent Sig ature of Contractor/License Hold r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledged�_efore me
this day of 20 _by this day of S 20 IS by
i fy dA✓�
(Name of person acknowledging) (Na aol person acknowledging)
V!
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known Z OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Com �N„ANN, s :r•' (Seal)
NIZ4;d TUREAULT .;• 'r k-4Q1SS10N#FF 90 M
ISSIOUROMW E.
- EXPIRES:September 13,2019 jfF�a BandeoThruNotafyPut�clJnderrritels
Revised 07/15/2014 BondeoTemNoWyPubGoundwitm
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER-- REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS