HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INFO ST BE OMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:FL=m ANN
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 i ndow
PROPOSED IMPROVEMENT LOCATION:
Address: 1000_C:�'On Lin I t a03
Legal Description: 041a 1-t-is itI bLi 4he Unit a03 nod nro- LQA. a sbare_
i n Cl�t'6lIrYYI 11 F'i P'm tlfiS .
Property Tax ID#: 4-YJI 1 S I(2)-001 1 - oco - 1 Lot No.
Site Plan Name: @fnflbS = Block No.
Project Name: V�C_hS
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Rel�v e ani re,�lo�C� �3� w►ncloVUg wi�-}1 ; nn�c�Ct.
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit-check all appy:
HVAC . Gas Tank E]Gas Piping Shutters gwindows/Doors
Electric. ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ���? 'J.CC) Utilities:Sewer OSeptic Building Height:
OWNERAESSEE: CONTRACTOR: ,�t
Name Rnh 4Tf-fn We�1S Name: oaacl Lpf)c al.e.
Address: IC)o1Cf'i S ( n br Un i j ZO Company:F1e_GAS
city: J etlS eCl Qja) `ACJ State: r-L Address: aF.5-lb G E NI Xi P -�W U
Zip Code: 5-1 Fax: City: s-1uftf-t State:-F—L
Phone No. Zip Code: 2CR-7 Fax: �� 04tol
E-Mail: +-__rr!we11S4I (a0YY) Phone No. 8L�)6• (3LAIS9
Fill in fee simple Title Holder on next page(if different E-Mail:. j 1,,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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 inur paying twice for
improvements to your property.A Notice of Commencement must be recorded an osted on the jobsite
before the first inspection. If you intend to obtain financing, consult ' h lender or n attorney before
commencingwork or recordingour Notice of Comm en en .
s
_Sig ature of Owner/Lessee/Agent Signa ur ontrac License Holder
STATE OF FLORIDAFLORIDA
COUNTYOF ����� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 18 day of. A 0115 20 /ter"by this 18 day of A-LlL7US& 20 by
bovid Lc Frade
(Name of person ack w- ing) (Name of per on acknowledging)
(Sig ature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
WOo� agAJeWNepUoW ES 10-96£(LOY)
Personally Knowt R gli IdentifireatioPersonally Kn ent'ica on
: n
Type of Identific 'n -r c}:�i:e Type of Identi
'( PIRES 11-111113A( x)18 )130HANIA11-111113A(Seal) Commission
Commission No. r 1� (Sed#� tl'••`
407)398-0 53 lOrio:e.. •i
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS