HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )� (,,
Date: �� Permit Number: us > �3 I
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 124 SE PRIMA VISTA BLVD
Legal Description: RIVER PARK-UNIT 5 BILK 50 W 35 FT OF LOT 121 AND E 45 FT OF LOT 13
(PARCEL 34/28N)(OR 3692-1058)
Property Tax ID#: 3419-540-0236-000-7 Lot No. 13
Site Plan Name: 124 SE PRIMA VISTA BLVD Block No. 50
Project Name: 124 SE PRIMA VISTA BLVD
Setbacks Front Back: Right Side: Left Side:
r �
-
BUILDING , TILE, REPLACEMENT ALL WINDOWS AND FRONT ENTRY v
_D
rCONSTRUCTION INFC►RMATION
,Additional work toe nartorme uncler this permit-check k a appy: �
❑HVAC 0Gas Tank as Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers 0Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 2,400.00 Utilities:Sewer FiSeptic Building Height:
OWNER/LESSEE r CONTRACTOR
,.
�;
Name Name:
Address:5407 S INDIAN RIVER DR Company: ALPHA DESIGN CONTRACTOR LLC
City: FORT PIERCE State:_ Address: 1492 SE BELCREST ST
Zip Code: 34982 Fax: City: PORT SAINT LUCIE State:FL
Phone No.917-682-9809 Zip Code: 34952 Fax:
E-Mail: Phone No. 772;-446-5329
Fill in fee simple Title Holder on next page(if different E-Mail: nicomagUln(a-PhO mal .com
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,PPLEMENTALCONSTRUCTION L1ENLAW.INFORMATION
T ..
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 alto y before
commencing work or recosdinzWur Notice of Commencement.
� s
_Signature o- wner/Lessee/Agent Signature o ontractor/License Holder
STATE OF FLORI STATE OF FLOR-IJ
COUNTY OF_� COUNTY OF_ J_A V��
The for oIng instr ent was acknowledgedbefore me The forgoing instrument was acknowledged b fore me
this day of U.d 20/�by this -2Uday of 2C / by
k-
(Nah)e~sbfi_acVn_�0wledging) (=acknowledging)
(Signature of Nota"lubc-Public- te of Florida) (Signature of Notary Public-State'of Florida )
Personally Knownroduced Identification Personally Known y 012=P
Type of Identificati ., a of Identification Pr`d4 ''% DAWN MILON
u?!d�, Bfli.li MIL9(4E— _ �i
,,os Notary ary Public-State of Florida
,1,`�: Notary Public-State of Flo ida r'
Commission No. i = * 'U• saa p mission No. ,;, .'r My CoM� fyires Mar 22,2017 '
• mm.Ex fres Mar 22, 0 0- ��'c
y T� •'; P,.•' Co mission#EE 877571
�, Commission#EE 87757 oFi�o,
o,.
«��,.• Bonded Through National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS