HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO�I JIUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7� �� Permit Number: SOS
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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 IMPROVEMEVT LOCATION f
Address:--7293 Sad8)-e_br60Y_ FL k349y(oi
Legal DescriptionN-z; NL-Phmg_ I 1- Lb (i.3�g vq g (6- 35:ri
PropertyTaxlD#: Z1 -5VZ-�oO -� LotNo`/ /
Site Plan Name: ~ 93 SAbS L��r Block No.
Project Name: f
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK ' .. r
CA reF�e-. c,'-3 y til fJF coca vl+y.. e�
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CONSTRUCTION IN+FORM% TION
Aciditional work to be nertormecl uncier this permit-checK all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq.Ft of Construction: t I Sq.Ft.of First Floor:
Cost of Construction:$ 2- Z 3 i . 00 - Utilities: Sewer❑Septic Building Height: 2U
LES TR 1 J '{ CONTRACTOR
Name-- � Name: -Frees ►�1�L-►'c�4-
Address: CL Q Company:Am eric wn
City: S L State:_ Address: & go-'o( se- --:17yul ian S7-
Zip Code:34-01�?(v Fax: City: S-I:u R-V-+- State: P
Phone No. Zip Code: 3L(-(J 5") . Fax: L412 -OSS In
E-Mail: Phone No. -71'2--Z� 45t0to
Fill in fee simple Title Holder on next page(if different E-Mail:(f wie-rXao J66 ��►�u'di4�� LA�i.�
from the Owner listed above) State or County License: 4(DtD.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPP�LEMENT�AL�CONSTR'UC�TION LIENL'AIN INFORMATIaN�� � - �l
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 ork or recor 'ng your Notice of Commencement.
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, 16or W Y'.._ — ® r�'lJs
(2ignatureof
wner/L sse Agent Sign t of Co ractor/Li ns Holder
STATE OF STATE OF FLORIDA
COUNTY OF it 1� COUNTY OF I I � �l Vl
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this IZ 1w C—
day of 1 x —f , 20 E -by this �-7 day of UiA$ ,20 l 55—by
1
(Name of perso acknowledging) (Na of per on ac wledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personall Known V P I 'fication Person Produced Identification
Type o n ' c do ro uCCe Type of ep f tion ro�uCe
u Notary ublic any o ary ublic e o o a
_ Liah Joslin Liah Joslin
Commi ! < My commission FF1s0505(Sea Comm! I ,F' My Commission FF 180505 (S 1)
?�ao� ExpMu 12/02J2D78 a►Mw ExPires 12/02/2018
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS