HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
/749
Building
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V/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 iMPROVEMENT-LOCATION:
Address: 255 2- Ant n,,--
Legal
t _Legal Description: l0,;,c.,c A.f Hlf, gtA:p 4 k"e- 21
Property Tax ID 9: X322- 5 2S-- C00 Lot No. 01-11
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:'.
CONSTRUCTION INFORMATION;...
ditional work tobe pertormed under t ispermit—c e a11 appy:
HVAC 11 Gas Tank Gas Piping _Shutters Windows Doors
Electric Zr-Plumbing ❑Sprinklers FIGenerator Roof
Total Sq.Ft of Construction: 5cl. Ft, of First Floor:
Cost of Construction:$_ 5S� Utilities: Sewer ElSeptic Building Height:
OWNER%LESSEE:: CONTRACTO'R. : . . ,
Name Name: 'Tlif PA1']_
Address: S W,141.1 _LA Company: GenzsiislA&46LN Sendiyes—r'nc,
City: ae,4- S+,- wf _ State: Address:Jq0a SE $aHp� �_
Zip Code: 3q q'W Fax: City: do i State: VL
Phone No. - 0,5"- Zip Code: '3q 9�Z_ Fax:7012-335-a680
E-Mail: _ Phone No. 1-7 a(.$
Fill in fee simple Title Holder on next page(if differentE-Mail: �¢r�sls{� r+tib+ $erv� m • ' girh
from the Owner listed above) State or County License:C I42 6
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required-
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SUPgL€.i IfNTAiL C NS1'RUCTION LIEN-LAW.INFORMATION
6E9IGNER/1: GINEER: _Nat Applicable MORTGAGE COMPANY: Not Applicable
Name, Name:
Address: Address:
City: State: City: State-
Zip: Phone: Zip: Phone:
FEE SIMPLE TUTEE HOLDER: „Not Applicable BONDING COMPANY: _ Not Applicable
Name: Nance:
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 Counter makes no representation that is granting a permit will authorize the permit holderto build the subject structure
which is in conflict with any applicable Nome 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
commencin work or recording our Notice of Commencement.
_Slgnature of Owner/Lessee gent Signature of Contractor/License Holder
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OF �. .. �` COUNTY OF S'/
The forgoing instrumentwas acknowledgedore me The forgoing instrument was acknowledged before me
this 10 day of llfoir�t,r ta{r 20 i!?by this16 day of 3Jci vet, t{lz cC ,zo L'�by
(Na son ck gl (Name er5 n a Ing
AlCK
G 3
Si t o ' anic�v ooR Ada
Personally Knawri , DR Produced Identification Personally Known OR Produced Identification
ype 'Produced ype tion Produced
Commission No. (Seal) Commission No. (Seal)
Devised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ; REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS i
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