HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED0_
Date:. g o�`� Ol- Permit Number:
•
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 IMPROVEMENT:LOCATION:
Address::. 3;L_(0 0 -Uh i l-)_o ti 3qqq9
Legal Description: ��A ��mS )l1�Ll 120 ao
Property Tax ID#: l ZS— 600 — O I 0 -7 - 000 — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
: 1-1-fr�,i 0 N cc- ys .v �k C�o.Y-y S\-v, .\1Q-r S- P�,C_CDte +tom
CONSTRUCTION'INFORMATION:
Additional wor .to Ieenel orme under this.permit-check a appy:
CIHVAC. L_J E .
Gas Tank Gas Piping MGenerator
Shutters Windows/Doors
Electric Plumbing .Sprinklers F] Roof
Total Sq. Ft.of Construction: Sq..Ft.of First.Floor:
Cost of Construction:$ -7, 3 9 Utilitiesf]Sewer E Septic Building Height:
OWNER/LESSEE CONTRACTOR'
Name La—Ne- CF s YVL i A-�q Name: -\C'a A Q55 e
Address: 001 R,/e- Sc- Company: b.\ .F [�iVy'i cane-
City: e e w�A) e- State: W4 Address: 3 to 0
Zip Code: 99 I l b Fax: City: C-5�- V,2{CQ :State: i
Phone No. 0 -..:;)Lo Zip Code: 3 qS) Fax: 'l SCID
E-Mail: Phone No.
Fill in'fee simple Title Holder on next page(if different E-Mail: C�V�l'►u r r°cct✓��S�u ers i rlc�i7n a
Co
from the Owner listed above) State or County License: 3 `lc1
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 thepermit 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 work or recording our Notice of Commencement.
aii�V-1-,nL . � �-- - S
_Signatu a of Owner/Lessee/Agent Signature I
Contractor/License Holder
STATE OF FLORIDAL
STATE OF FLORIDA
COUNTY OF COUNTY OF � Q C1 I�
The forgoing instru Ant was acknowledged�°re me Th rg ing instrum t was acknowledged before me
this�ay of 20 fib, th' ,Vday of 20 by
r (� I 1
(Name of person acknowledging) (N a of person acknowledging)
n ry-Public-State of Florida) (Signa ;a State of Florida)
Personally�r .o�.���� R Produced Identification ersonally :ter •°_ � �Rr entification
ro uc Type of I Pfodcd p
fil
Commis@i n=,,.p ,• NOtary publIC�SM t �l al) Commission No. •e0 de°mm F p7° `fp?��8})d
9 Y Comarf—m Expire 0" SionFF 234730 Fibrida °u9hNa"0,7. ay?�20 a
�* ugh NatlonalNotall
Revised 07/15/2014 ry AssnASsn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS