HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: RECEIVr-70 NOV I 3PitNumber: 511 - (5 R.30
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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 X_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCATION:Address: 611 Ln t'G� f Z_ :3 l9�sC
Legal Description: 94/e.r /91/r 61,04Y_ �/�'lu 3Y/,2ZTJ
Property Tax ID#: O- &0-0-3 Lot No.
Site Plan Name: Block No. -2-2
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION`OFWORK:
61ver 11.7 jJ 211 J 4- /'L.-Of a.✓Qi' e�;'1"r �''-y Jam. �G° { 5/;?
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CONSTRUCTION INFORMATION:
.A,dditional work to e e orme under this permit—check a appy:
HVAC f]Gas Tank ❑Gas PipingShutters a Windows/Doors
Electric 0 Plumbing []Sprinklers E_Generator ElRoof
Total Sq.Ft of Construction: Z2-d'q S . Ft.of First Floor: 1�J 3�
Cost of Construction:$ .21 0�� Utilities:ll Sewer F]Septic Building Height:
OWNER/LESSEE: . ��:�CONTRACTOR: .
Name S,n v� /3 Name: So -Nei u- e
Address: Rom,,o In Company:ir�
City:Vor State: Address: 13;V TW 13; __TA
Zip Code: 3 5-2 Fax: City: State: r�-
Phone No. Zip Code: Fax-- 7yz-3Y3-,?35rr
E-Mail: Phone No. '77_7-3'70-977e
Fill in fee simple Title Holder on next page(if different E-Mail:TC P,,e, f',,,Lg L/-C 6) 4ozzo'/.c_c/o
from the Owner listed above) State or County License: ;33 oG3'3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION',:
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 the permit 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
commencing work or recording our Notice of Commencement.
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_Signature o caner/Lesse Agent Signature of Contraefor/Lljcense,HAder
STATE OF FLORI -A STATE OF FLORIDA
COUNTY OF ,LCOUNTY OF _7 Z--,,'e
The forgoing instrumeq was acknowledged before me The forgoing instrumewps acknowledged before me
this-27 day of c Ee- 20 1 S by this l7 day of e6 QO'r .20 1.5 by
)u"i-1 i3Mlle — ����
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(Name of person acknowledging) (Name of
person acknowledging) Q, RT BA
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(Signature of Notary Public-State of Florj? ) ��r ,Signature of Notary Public-Stat$V7®9,0 u': s o 22434
Personally Known OR Produced @i�tific§6122434 _fersonally Known�OR Prcfdy�r '�� 0416"!�
Type of Identification Produced r�99. �ndedms+..° o hype of Identification Produced ;o.��'9ll//�'°�•,•�°•pF_F�;N;`
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Commission No. 1.2200 C/ (Sea l�'iii��lllSTATE()\V N Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS7—