HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: II Permit Number: C1
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
PRS O E� . . , •: _• . . - -
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Address: M01 QUWA Clara &MI_euC•rJ Fed !Pk1 l _
Legal Description: WKQ- zod Pofy-- VA4--al 151 K_ 19 1 & M MW 13101 N)C,M-31LM
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Property Tax ID#: 122AD11 .-- G 11 -::0 `OCA~4 Lot No---z8
Site Plan Name: Block No.
Project dame:
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Setbacks Front Back: Right Side: Left Side:
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AdditionalworKtOpenerformed unclert is permit-check all appy:
0HVAC EhasTank E]Gas Piping _Shutters Windows/Doors
Electric ❑Plumbing OSprinkiers []Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ � �[] _ Utilities: Sewer Septic Building Height:
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Address es Company: }�, 5 r G7re000Wtf1Gl �-
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Zip Code: ` Fax,. ¢ � City: C`o
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Phone No._��.�} �_ j Zip Code: I';'S Fax:� @)T4_+-LR;
E-Mail- Phone No. �4►'1� -2-, -$�
Fill in fee simple Title Holder on next page(if different E-Mail: L CQ Ir i CLAVI
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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: T City
Zip: Phone: Zip:. Phone:
I certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie Count/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 s 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 ongecWing your Notice of Commencement.
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SignatuWAe ssee/Agent Signature of C ra or/ cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF_ COUNTYOF M_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this?Z day of . iMbkr , 20 13by this°Z day of N N11MIO 1r ,20 la by
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(Name of person acki edging) (Name of pers a owledging)
INALVIS MARTINS_ i�tpr k�
£�;� INAL.VIS MARTINEZ
(Signature � �t9t' e,ige ta,zn78 (signature tary Pu t ]g
August 74,207$
Personally Known �aoi>asso Firn:�_: ti:c� on ramjraggq,�s ,�
Personally Known
Type of Identification Produced 43(Q�� Type of identification Producedt 3l1f 0--1
Commission No. (Seal) Commission No.M16151f5 (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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