HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / �} ' , 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 u
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
ROPO
P SED IMP
ROVEMENT LOCATION
Address: 7(;-0 08-aot-y CoV,129z:Y
Legal Description: ISL_ft-^J0 Z�)rYt5 co rv✓xye, cr A k A
Property Tax ID#: 3 5'-55--(1:101 -00D 3 'CCXD- Lot No.
Site Plan Name: CO v2,bR4_-y Block No.
Project Name: Coa-#'D at-:,
Setbacks Front Back: Right Side: Left Side:
DESTAILED DESCRIPTIONF WORK $ `
C NSTftUCTIfJN INFORIVIATIOfV
Additional work toe e orme under this permit-check a appy:
E1HVAC Ei Gas Tank E]Gas Piping _Shutters &indows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Zd, 0013Utilities: _Sewer F]Septic Building Height:
t : LESS
qac CONTRACTOR 4
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Name C iOLb �u tJl2�`ti Name: �
Address: '8-7 DO 5 D(Z�Z�� Company:
City: 1-�egaki G}GIf State:, Address:
Zip Code: y Fax: City: —State./
Phone No. v�2 - Flo Zip Code: 3 111q,& Fax: 60 92`97W`{
E-Mail: Phone No. Z O Z -97Y
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: �'� G 1 sZf 4/3!Z
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.0PPLE'MEN`f`L CONSTFtUCTI N LIENrLAW INFORMATIC?N
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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 propert A Notice of Commencement must be record ed,
and posted on the jobsite
before the first inspectio . du i t nd to obtain financing, suit with n r or attorney before
commencin work or r d'ri r Notice of CommencqRlenV.
s
Sign ate o Owner/Les a/Agent S.gn ture of Contract o icense Holder
-STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF __moi COUNTY OF S7—
The
iThe forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi7 'ay of 20/ th_,,7��ay of ����T 20/ by
(Name of person acknowledging) (Name of person acknowledging)
(Signa of Notary Pu lic-State of Florida) (Signatu Notary Pudic-State o Florida)
Personally Known ✓ OR Produced Identification Personally Known 1/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ANN M.(i( M9 D Commi ick ANN u.G+uuOND (S I)
;Y COMMISSION'#F 17390r ')' MY COMMISSION#FF 173907
z
EXPIRES:December 7,2018 �y a: A EXPIRES:December 7,2018
•„Rai,.• on ru Notary u n e ers
Revised 07/15 2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS