HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �l I �-I\ Permit Number: U a
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
PROPOSED IM'PROVEMENT'LOCATION:
Address: Am a. C 1\zAe.� ?ie\rc-(L F�C 3 4 M,
L� esc�o�e- _Cie.nnDV'2,, �(X))Nyf" W)y"&oW� In5�-dkk r\eu) )n1 + ltdin l
V'tTV10ve. ok� ylnMW-,( Va\v-e, ty�sVG\1 rl^J 5�n�.> f \Ja\Ve.
PropertyTax ID#: �Ag-g-to01{--0033--opo- Lf Lot No.
Site Plan Name: W-% ,50(\ Block No.
Project Name: S l&o6ao \N ASo)n
Setbacks Front Back: Right Side: Left Side:
[7DE1'.LED 'b SCCRIPTION OF WORK:
a rerv%ovv. �w 4\&r0ocvN Wt._AMJ v,.e_J l,u�pcac,-+ us►tis
o v'Qynno\je, $hr wv_ ,.r ua\sQ, cL-A ro placx thtt f.. oke-j VcLtwe.-
CONSTRUCTION INFORMATION-
Additional work to be e Orme un er this permit-check a appy:
HVAC Gas Tank F]Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing O Sprinklers MGenerator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$1500. OD Utilities:n Sewer ElSeptic Building Height:
OWNER/LESSEE: ;CONTRACTOR:
Y
Name SUSar% \N%\Soyn Name: b co 10
Address:'Qab% E)�2e�be�r� Aye.n we. Company:�Q\rt,n J a Gobs C0 V,5,N ruc kL*;\
City: r4 i18-CCD_ i'L State: AddressA10\ Meande.r i-vv-,
Zip Code: '34q2;2- Fax: City: 4 Flt,rCSL State: .
Phone No. 2')o-5 53 Zip Code:3'-ta8Z- Fax: I
E-Mail: Phone No. 11Z ni 9331
Fill in fee simple Title Holder on next page(if different E-Mail:,)W�OLCo)C;64-\o\ 'o G( C<<\# Czyv\
from the Owner listed above) State or County License:CPo(?,()(o U 21
IL=
nstruction is$2500 or more,a RECORDED Notice of Commencement is required.
.1
SUPPLEMENTAL CONSTRUCTION"LIEN LAW INFORMATION:
DESIGNER/ENGINEER: j,/ 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: _ of Applicable
Name: 4_a woo, 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
commencing work or recording our Notice of Commencement.
.4— \ I !�ft""'L� V �9" S
_Signata of Owne essee/Agent Signatur:FL(Contractor/Lice a Holder
STATE F FLORIQQ STATER)QA •
COUNTY OF S - LU Ll-e, COUNTY OF 4}- r
Q
}- \
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 17, day of tj rTR ! 20 LC this_L?:-day of PD-V 20 �by
3b 16 �0 c-0b� �o�v� 5kcx� s
(Name of person acknowledging) (Name of person acknowledging)
U_�to D*A� I LXXN0 .�)�
Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known V/^ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ommission No. (Seal)
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Revised 07/15/2014 f� � eot �'"N ��'" ' _ EXPIRES:September l3,tots
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS