HomeMy WebLinkAboutBuilding Permit Application , r
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / 22—(S Permit Number:
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 L"L
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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'OSE EM LUCATIN
Address: 2 :7 C) 2 l.1) /`
Legal Description:
Property Tax ID#: l/37 SSD 6 n/1� 4)n/cz Lot No. S-
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED bESCRIPTION OF WORK
r� �1 !Lzc ep /,i C 4-o e-vc loc&t ve- . Gi d /,-e w 12 e 57-'i
CONSTR15 UCTl1N;INFORIVIATICIN
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Additional war to be nertormed under this permit-check all appy:
IIHV,AC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
_Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1500 - Utilities:)Sewer Septic Building Height:
t}WNER/LESSEE CONTRACTOR
Name Ti,rvx r,,.i-e �
_ 4GVeAl� 0 _
Address: '27 U-1 1W xQ-( v L 2 Company: A lex kS'/.JP-e L�La d,4r,1 L
City: r P f eye c State: Address: cf O
Zip Code: 31-19 I/( Fax: City: FTP i e it c .F State:(
Phone No. '7-7�-- 6 -- Lf 15 3 Zip Code:._31-7 t/7 Fax:
E-Mail: Phone No. _72 Z IR-6 Ir 9
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: �06 6,2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SCJPPLEMENTAL CONSTRUCTION LIEN LAW INf�RMATI rt N
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.
Signature of Ow r/Ag ssee Signature of o ra ense Holder
STATE OF FLORIDASTATE OF FLORIDA 1
COUNTY OF ��'� L V� G t COUNTY OF
- at 2—u-C-16Q�_
Theing instru nt was acknowledged efore me The fo g instrumen was acknowledged b e me
thiso ay of 20-15 by this of 20 4 y
(Name of perso acknowledging) (Name of persona know edgi )
M
(Signature of No P lic-State of Florida) nature of Notary blit-State of Florida)
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�a`��RY P�'•
Personally Know o mAR Pr uc@gQ }on Personally Known OR Pro�{ced Id tify'ration
Type of Identific [n P °fid N to U -, Type of Identification.ProducedtoolL_
ate: m +Y FF 234
730
Commission No. ''%aoFr��o �• My Comm.E4g4WMgaY 27 2019 Commission 'n � '•., ANGELA M
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS