HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE'I FO MUST BI COM�TED FOR APPLICATION TO BE ACCEPTED
Date: l Permit Number: C( � 4
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED INfPROVEMENT LOCATION
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Address: �020� CJ
Legal Description: A?-LA /S ,e Oy -r� 5-54 UN/T P11 se, 7c:>S-) Amo 2rJ
4prA 5ex'kl e /a C0A4rr.0N L-2F.nilt e 6 37-, 880$: 0-7 - 2 1"17,3
Property Tax ID#: '��/� -S/S -06 G ') 0�- (O Lot No.
Site Plan Name: A40 SG/4 Block No.
Project Name: /L10!;G?}-
Setbacks Front N Back: Right Side: N Left Side: N
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work to be nertormed under this permit-check a appy:
❑HVAC Gas Tank Gas Piping ShuttersWindows/Doors
Electric ❑ Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: 4 S . Ft.of First Floor:
Cost of Construction:$ OM Utilities: _Sewer OSeptic Building Height:
OWNER/LESSEE
' ` - CONTRACTOR
Name G/A0*4- 0564' Name: 622PA11^1
Address: J199 5W / -','& ,on 6W Company: 1EMETI q42tr� ,�G/I74jNis�'1
City: ( State: R- Address: (79,) /IW1��?_A-/ h
Zip Code: 3Y 9�in Fax: City: .94ot" — State: /2_
Phone No. A8&' S$9 Zip Code: Y g4 Fax:
E-Mail: Phone No. Z -UE7q0
Fill in fee simple Title Holder on next page(if different E-Mail: /�/G/ L����✓��.��C,��1,�,G�Jf�
from the Owner listed above) State or County License: C6C /5 (9 4'T�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENLAIN`INFORMATION
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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 an attorney before
commencing work or recording our Notice of Commencement.
s
_Sign ure of Owner ssee Agent Sig u e of Contract r/L cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST UGl,-4-- COUNTY OF S:7—
The
TThe forgot g instrument�was acknowledged before me The forgoing instrument was acknowledged before me
this, 'y of /(�//// 20/3by this/7�%_ ay of AZ// 20 16'by
(Name of person acknowledging) (Name of person acknowledging)
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(Signa u�r�Notary Publics-State of Florida) (Signat Notary Pub rc-State o�FTorida)
Personally Known_V-1" OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. AANt�SI �AUMOND Commission No. `;„9P" ANN OND
MY COA�MISSIbN#FF 173907 ; MY COMMISSION#FF 17390711
EXPIRES:December 7,2018Bonded ThrdWle Public 11 : EXPIRES:December 7,2018
H•
•„or�y,.• tioncea I 11rtJ Notary Pu6 is Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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