HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO rU T BBEE OM TED FOR APPLICATION TO BE ACCEPTED I —
Date: 1P I C J 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: To Select from dropbox, click arrow at the end of line
P.,ROPQSED".IMPRWEM,ENT LOCATIQ//N :
Address:
Legal Description: Oce IqA( ' .57D'4-r f Go•v00 Aon Q acv t
Property Tax ID#: /7 —OO Z s3- 600 Lot No.
Site Plan Name: 10 r(,DM/V0 it— Block No.
Project Name: 0 r A, Pt--
Setbacks
t/Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION ,G1=WORK.
Tow, Plftt_71AC —
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,1%5 cL,)j
CONSTRUCTIQNrINFORM%ATION
._
Additionalwork toe e orme under this permit—check a app y:
HVAC E]Gas Tank ❑Gas Piping _Shutters / Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ i If—() ' Utilities:n Sewer O Septic Building Height:
01NN ER/LESSEE. CONI"RACTO.R:
t _. .. . . ._ N
Name it.`/R t r L601V^'0 ?' Name: /G
Address:_/Z7R9 4_JW AlWa/M C.-r-- Company: 7Z-Wt—O i = 4(1> ^-I
City: e,s✓I C,12:;1 State:_ Address: ! W
Zip Code: 3'1 44 a Fax: YA City: Stater
Phone No. 37-11; Zip Code: 2&1//e, Fax:
(/ 7 47to
E-Mail: Phone No. Z 'O $D
Fill in fee simple Title Holder on next page (if different E-Mail: A&e-IAZLC? 4at4N
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5tJPPLEMENTL CNSTRUCTION LIENLAIIV INAT.ION s,
,Y
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, consult with lender or an attorney before
comme cin work or recording our Notice of Commencement.
s
ignatur of Owne La�ss� Agent Sig atu of Contracto i o er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��j �1'G/ COUNTY OF -<,-7— kC�C/�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
tl>,3N' c ay of•(�"/ , 2Q/��by t �ay of/` "1�/' �— ,20%S by
(Name of person acknowledging) (Name of person acknowledging)
(Signature Notary PublicState of Florida) (Sign atur Notary Public= te Staof—Florida)
Personally Known OR Produced Identification Personally Known �" OR Produced Identification
Type of Identification Produced Type of Identification Produced
..�r..y.
Commission No. ANN M.f�++l� qND :j ,• *r"i''% ANNM.GAUM Bal
COMMISStONIiF 173907 Commission N NF1 )
.__ MY COMMISSION#FF 173907
=s:• EXPIRES:December 7,2018 y'• ;P EXPIRES:December 7,2018
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS