HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: ' Permit Number: 1511 -D303
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 IMPROVEMENT LOCATION
Address: �'1 R 1016YYl t 3
Legal Description: C\YlY)QPA V \�\1 L {db r
1r
Property Tax ID#: 4 42 S- Q O2 - U(�) L b l) - Lot No.
Site Plan Name: 0 Co_ A Ln) t\ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION OF.WORK
t
CQNSTRUCTION'INFORMATI0
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0.
Aciclitional work to be nerrormed under this permit-c ec a app y:
❑HVAC Gas Tank F_1 Gas Piping OGenerator
Shutters QWindows/DoorsElectric Plumbing ❑Sprinklers ❑ Roof
Total Sq. Ft of Construction: U S . Ft.of First Floor:
v�
Cost of Construction:$ 43 5 Utilities: Sewer❑Septic Building Height:
OWNER/LESSEE CONTRACTOR
,.. :. .
Name Name: 17) -e r KA
Address: (Z�U� w !``c�?na►� a� W Company: R(h-1_3�-i Ca-h );'Pcue
City: i9Dc. Stater Address:IW 1 S)27 @ o S
Zip Code:3`'f q 9 p Fax: City: vi,/-4- State:L_L
Phone No.5(Pi- _-�D a -�� Cv Zip Code: 2 L-(5 11 Fax:_ I-( I T OS"7Co
E-Mail: Phone No. 2 U3- LfS�lQ
Fill in fee simple Title Holder on next page(if different E-Mail: ri (_ C-�-'A-bk obar
from the Owner listed above) State or County License: La �0 `J
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
; ' RP!EMEITIL CONSTRlCT1CN LIEN,IAWNFORMATIQN � :' ; N
' ff+ ? dP i..a ;'aiM'�%S4 x ?.N'✓. i
DESIGNER/ENGINE_ER: Not.Appl cable` MORTGAGE COMPANY; Not Applicable
Name: Name;
Address Address:
City; State: City: State:
zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HCILDER: `Not Applicable BONDING CCIIVIPANY:
Not Applicable.
Name.: Name:
Address: Address_ .
City: City:
Zip; Phone: ... Zip; Phone:
Lcertify that-.'no work or installation has':commenced prior to the issuance of.a permit;
St.Lucie Counttyy makes n representation that.is granting a pernAt will authorize the permit holder to build the subject structure .
Which is in conflict with any applicable_Home Owners Association'rules;bylaws or and covenantsahat may;restrict,or prohibit such
structure:Please consult with your-Home Owners Association and review:your deed.for any restrictions which may appy.
In consideratiorr_of the granting of this requested permit,i do hereby;,agree.that Lwill in all respects,perform ttie-work
in accordance with the approved plans;the Florida.Building•Codes and St.Lucie County Amendments:
The following building permit:bpplications are exempt from undergoing a full•concurrency review:eodm additions;.
accessory Wa6tures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential.use
WARNING`TQ OWNER:Yourfailure 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 bran attorney before
commencing work or recording our Notice:of Commencement.
...�.. s
Signature of Owherj'!_essee/Agent nature of Contractor/License Nol er,
STAVE OF FLOR }/� ( STATE OF,FLORIDA
COUNTY OF--i�-` 6�-�c �t COUNTY OF _. '1�1- I
The f�rgoing-instru ,ent wnAa�a�c�k wledge efore me The forgoing instrument was acknowledged before rile
this J day of�� Idw i .,.20 by this,day of.
Gil e iM b�r�,20. by
erson acknowied in
(Nam g �, (Nam of'Person.acknowledging). •"�
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•.... 9�,Kr�
(Signature of Notary'PUbl_-State of Flo ` a '�'oi O, F'P (Signature of.Not Public State of Florida %�c,°'s
Persoriaily ICnawn V OR Produces#Ide ci# oSd+ Personally Known OR Produced idents c�,it rf
Type of Identification Produced °a o Type:of identification Produced �3Ile,
N
Nb ri m
Commission.No: (Seal} ~c ,�E`�, mrnission No. (Sel: � T
CP
Rewsed,07/35/20.1.4.
REVIEWS FRONT 20NING SUPERVISOR PLANS VEGETATION SEATURTL-E : ,MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE_
INITIALS