HomeMy WebLinkAboutBuilding Permit Application -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � � 1f' • �.� 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:
One
Mll
Address: 76 6 /U L d2 L X12 1 tkj AI fa
Legal Description: -r.�A-t� �L u eglorn Y — J {`�/� L d 7 Y
Property Tax ID#: �� �� '� y — 0069 — O00 — o Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit–c ect all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 42� D 6 Utilities: —Sewer _Septic Building Height:
Ma A� , 4n �•*' ZtJYY+ Name: S ® 4eJS 1
,b".4',!f A /:7, VC, Company:we'-f-S csyt Guo-)'r 01`7ewe- L wc-
' ( ?KJ t State: 1 Address::.,13YO fu-, (J-e-c/'terd c h Il-VS
Zip Code: .3 VT F7 Fax: // City: A40 ,' lam/
["EY State:
Phone No.�7�– s 6 � 14 I F 2 6 Zip Code: 7(/55J— Fax: 77.) —YJ-9
E-Mail: J?e. ,,,4 y JY4 PY41 6dG ,Cvn^ Phone No. X2 11`169 e fit
Fill in fee simple Title Holder on next page(if different E-Mail: Z+_5�0,.VL,0 t., C 13e 1 Jo
from the Owner listed above) State or County License: L 3--'7
7 7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNS ENGINEER.
Not Applicable MORTGAGE;COMPANY:. K
' Not Appiicable
Name: Name:
Address: Address:
City: State: City: Stiate;
Zip: Phoria Zip: Phd.it. ;Y
FEE SIMPLE-TITLE HOLDER: Not Applicable BONDING COMPANY: -,.„Not Applicable
Name: Name:
Address: . Address: "
City: "City.
Zip: Phone:. .. ... .. Zip: Phone:
OWIitER/C�CINTRACTQRaFIDi(IT: pptiratian t5 hereby made;to obtain; perrn:t to tto ft-Work,and Installation as indicated.
lcertW that r qty dr instl me i ct prlort �s r+ce of a Remi€t4 `
St.Lucie County m kes r10 representation that is gran;Ing a'permit will a�uT�drize the eritilt.holder to,bulid the subject structure.
which fs in con ict nrith anyapplicabIq Home Owners,Assoc atldrf rules, yli*s or"andpc ovenants thafmay restrictor prohibit such
structure.Please cansUlt with,your dome Dwners Association and reylew you deed.for any restrictions which may apply:
In consideration-of the granting"oftitis request i:permit,l doher`ebyagree,ihat I"wtil,in_ail-respects;perfvn i-the iivork
in accordance with the approved plans,the Florida Building Codes and St,LucieCounty Amendments.
The followingbu.ilding permit�applications are:exempt from unddergoing a full;concurrency,review:robin additions, „
accessory structu'Ms;.swimm€ng pools,fences,walls,slgris,screen roomsand accessory uses to`enother non-residential use
WARNING TO OWNER;Ygvrfallure-to Record•a Notice of-Commencement may.result-in your•paying t�nrlce for
impprovements to'your property.A Notice of Commencement must be recorded and posted on the jobsite ,
before the first.inspe loin:If you intend'to,obtaln f{nanci ft consult,with lendor or an-attorneybefore
commencin vuork recordin our:Notice..of Commencement.
ell
Slg
e or owner ant/Lessee Slgnatu e' Cont or/tloense Haltler
STATE OF FLQR[DA STATE OF°FLpRID
COUNTY OF ,�: � CQUNTY'OF � �Z
,. Tthhifgdag+�iontsjfer=t .�o re me -. tbls��i�ng1�ipostr eqt.�a�s ack owle2d be;me
The';eoroin
by • - " ,
(Name of pe gid ac ow a,. ng) (Name of on a owledg€ng)
�f(SI use of Notari►Pudic-Sta . fFlo ' ) (Si : tura of Notary Publtc= to of Florida)
Personally Known_ diced IdeRt igl . ersonaliylCnown ten
type'of ldentitcation N°taF Pyyurtttc�.:sil�rpp. �tArMr . a of,ideritifiction uc
Prtid
' r ♦ V D�IR!=8M7�rY 24f�j l 777
,•, ` `` *na+A�il 7•�T. 4PSi.
Corritnlsslon too �F . �°`M&�:Fn;avn 2Q, mmission No. Expires ii�t
all
RE1[IEWS FRONT.. : ZONING SUPERVISOR 'PLANS VEGETATION 'SEATURTLE MANGROVE;
COUNTER REVI.EViI REVIEIAI . REVIEW REVIEW; REVIEW REVIEW
DATE
RECEIVED.
PATE
C{3MPLETED .:
ev.