HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /�
Date: Permit Number: 150 O�O�
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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 11NIPROVEMENT"LOCATION
Address: h Q,C*O S Q(&A,,,z
Legal Description: dl4S Mi&A /H , UN i T ?W h� Q 1�i 5 4YI,Z6— /N
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Property Tax ID#: VS-0 7-- 701 - co 13 - OOc3 - Lot No.
Site Plan Name: eZ45-5 Block No.
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Project Name: I� 45S
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK >
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=CONSTRUCTION INFORMATI"ONz
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Additionalwork toe performed under this permit-check all appy:
HVAC Gas Tank []Gas Piping Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$�of Utilities:cn Sewer[]Septic Building Height:
01NNER/LESSEE Y, CONTRACTQR -
Name Name: Z�/
Address: /coon � Company: AAA.) At✓>
City: za&69q 1CAddress:
Zip Code: Fax: City: 5— State:
Phone No. :7 1% X01 - Zip Code:_ Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION L#ENSLAVU 1NFQRMATI0N
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 our property. A Notice of Commencement must be recorded and posted on the jobsite
before the first' s ecti /your
ntend to obtain financing, consult ' h lend r t rney before
commencingor ore r Notice of Commence
s
S�gnaidre of Owner/Les ee/Agent Signature of Contractor/Li rise Holder
STATE OF FLORIDA STATE OF FLORIDA /
COUNTY OF COUNTY OF —3-7—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiCl'ay of 20/,�by thiy of _1:5,,�/J% 20j�by
(Name of person acknowledging)� (Name of person acknowledging)
(Signature o otary Pu iic-State of Florida) (Signat f-Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ••'i'""'y''' ANNI&%MD Commission
.: .- COMMIS51 N�9�F 173907 •�1�:.."v,�= ANN M.GAUMOND
EXPIRES:December MY COMMISSION#k FF 173907
nded-Ttau-Notnl..1.
EXP
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ecem er
Revised 07/15/2014 ~'R�;r Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS