HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j2
Date: Permit Number: r �o '®cr?`3
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 'y�
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: 3,;?09 �A0A11,VOO.0
Legal Description: 5AVAIVIyA aYT - /'---/747 ' 7-
Property Tax ID#: 351,25 -70 2 0/9.3 - 00D - Lot No. 3
Site Plan Name: Block No.
Project Name: 5c A10
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O.F WORK
,654CT" AIC 5e 7-0,,v /4e sE2F.-c' .vc���
/-?5 ON,40 J/Xvkoaa
CONSTRUCTION-INFORMATION
Additional work toa er orme under this permit-check k a appy:
IIHVAC E]Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator EIRoof
Total Sq. Ft of Construction:� S . Ft. of First Floor:
Cost of Construction: $ TSDt� Utilities:lnSewer 0Septic Building Height:
OWN:ER/LESSEE: CO NTR�ACTOR
Name 71-10,10w45 Name:
Address: 3x08 Company: Aiarl-l�c_l 1;ye-
City: 1021:e% 5./— t_UC/�' State: /"e Addresses:: 25'110 S• � nyj' �
Zip Code: W375r2 Fax: City: M!W_ �� Fac State: r�
Phone No. ) �ga - �79� Zip Code: �� Fax:�� �-�D18
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail:_�� C Cyyl7
from the Owner listed above) State or County License: G/s--z7W.253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN,.LAV1/.INFO.RMATION: .
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, consultWith lender or an attorney before
commencin rec ,rcliW your Notice of Commencement.
s
_Signature of ner/Lessee/Agent Signature df ntra`ct r/License Holder
STATE OF COUNTY OF FLORIDA STATE/2e 4:1-1,
COUNTOY OF FLORIDA loeC
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this 9 day of t!!2e-7_0VjM 20 95"by this�29 day of l3AW20 /S by
(Name of person acknowledging) (Name of person acknowledging)
Sig' ature of Notary Public-State ofor da 0 TSigTiature of Notary Public-State lorid
Personally Known 4—OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Prod icow ayP ` fuer Type of Identification Produ
I
2 � NotaryPublic-State ofFlorida C�P0.YPGei Lisa Rodriguez
Commission No. c (8134ission#FF917447 Commission No. _ N&t O-Iblic-StateofFlorida
9lFOFF�OP\O Expires 10-Sep-19 m� a` Commission#FF917447
7l ?�
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS