HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INF9 MUST B COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
.:i���_
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
;PROPOSE;D IMPROVEMENT LOCATION:.
Address: W&00 S 046g21 ik 4/0/
Legal Description: M7W &AlaQ 27 64W7_ 'YO/ -/l //�✓/� ✓ S/
Property Tax ID#: z/3W S 17 —00 363 000 Lot No.
Site Plan Name: 4o/1.>' Block No.
Project Name:
Setbacks Front
A /A Back: A Right Side: /NV/7L,
NV Left Side:
DETAILED D.E$CRIPTION OF WORK
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1,%-6 OIV6�rr
CONSTRU -TION'INFORN ATION
,
Additionalwork toe performed un er t is permit—check all appy:
❑HVAC Gas Tank Gas Piping _Shutters 0 Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑Generator _Roof
Total Sq. Ft of Construction: SFt. of First Floor:
2
Cost of Construction:$ 00 Utilities:cn Sewer❑Septic Building Height:
ODUNER/LESSEE y* w CONTRACTOR
Name u c_(4 Name: Jif B! <f✓
Address: A3 L&v0 i-W Company: /c awl
City: State:AV Address: So t"
Zip Code: +n� Fax: City: Stat rL
Phone No.�/—d o°3 - y�3 Zip Code: ?L19'7z2" Fax: 61 Z
E-Mail: Phone No. 97 _ CGU
Fill in fee simple Title Holder on next page(if different E-Mail: 446,2.
from the Owner listed above) State or County License: -f-h :3 7—
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION'LiEN`LAW INFORNIi4TION
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 intencJAo obtain financing, consult with lender or an attorney before
commencing wor or,r rdi ur otice of Commencement.
s
_Sig re of Owner/Less Agent Signaturdtof Contractor License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF .�3T COUNTY OF 3,;;—
The
%The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
th�7Nay ofif�/�,Ef 20%by this��� ay of "��� �,20/S by
(Name of person acknowledging) (Name of person acknowledging)
(Signat f-Notary Pu -State of Florida) (Signa_t ef-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. ANN M. ®ASND Commission No
::° ? '"v• ANN M.GAUMOND
_t; :� MY COMMI5SION FF 1730 8ti +��;
_ EXPIR .: :.= MY COMMISSION#FF 173907
' °` Bonded Thru Nota Public Underwriters y'• S:December 7,2018
Farm"P` 'f pF Fy?' Bonded Thru Notary Public Undenrtiters
Revised 07/15
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS