HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��11 = //
Date: 1.21 Permit/ Permit Number: r V 3�2
te
s �
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 ly Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDSIMPR01lEMEIVT LO`CATIONAl/,k�
Address: 73-70 S CION/.1 c.. 515" x' TIE-A5&4
Legal Description: 3007 - cog 3—6--v— �
'1)UNE w ftV, L.. 't'�� >� a-(A sO�-0 0'�L'.M'16h, ti�r+ 3 Qf�I-Y S
Property Tax ID#: 22 0tJ Lot No.
Site Plan Name: 1 v1 C.�r- M `/J/� Block No.
Project Name: �
Setbacks Front In 14 Back:, N /a Right Side: N 0� Left Side:��
a _
D.ETA�LED DESCRtF'TIONfJFWORK � � � �
�,A/);),AJ 42e llj-u� - 2 vp7ml r-15
CONSTRUCTI-ON INFORMATION
Add
Mona I work to be De rtormed under this permit—Check all appy:
HVAC Gas Tank []Gas Piping _Shutters OWindows/Doors
11 Electric ❑Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ �t70o Utilities: Sewer Septic Building Height:
`OWN ER/LESSEE CONTRACTOR A
_ z
r
Name �i✓T � � 5i'SA-Pj Name: /C,
Address: 6o& Company: ^ A-0—IA"
City: 1HVS��/ State: Address: �4
Zip Code: 3W Ir? Fax: City: /fi-V7— Stater
Phone No. 221 — 51770 Zip Code: y C1 9 Fax: Z 7
E-Mail: Phone No. t'iJ�9 2 Cw 4 J
Fill in fee simple Title Holder on next page(if different E-Mail: JV 1614/ L_(y0Ot,-f'CJ 1)-N G
from the Owner listed above) State or County License: cj t/3
1f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL GQNSTRUCTION UEN LAW INFQRMATION f
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 ano po d on the jobsite
before the first inspection If Y16Y in nd to obtain financing, consult wi len r a orney before
commen r 'w rk o re �r Notice of Commencement.
V VL"
s
s` ature of Owner/Lesse gent Signature of Contractor/Lic a Holder
STATE OF FLORIDA �' STATE OF FLORIDA r
COUNTY OF l�,�l/� COUNTY OF vl,A)
The f r oing instr ent was cknowledged-bore me The fo. oing instA.Z
nts cknowledged before me
thi�kdaof tsGL' L' 20/b by thiso�day f 20 /rby
add
(Na of e o cknowledging) (Name of per on cknowledging)
U
of Notary Pu 'c-State f FI ida) (Signature f Notary Publi State of FloridKnown OR Produ d I entification Personally nown OR Produced Ide ' i tion
ntification Produced Type of ntification Produced
/
Commission No. i3 !/ (Seal) Commission No. 1 (�t�(�! (Seal)
JOHN LEE TINNE�� ���;,aY P�.,, JOHN LEE TINNEY
Public- ate of Florida :r. �': o ary Public tate o Florida
»• My Comm.Expires Nov 15,2018 + »•=My Comm.Expires Nov 15,2018
Revised 07/15/2 ;;, c;: Commission#FF 165316
'��a `oP°;� Commisslon#FF 165316
ary n. sn.
REVIEWS FRONT ZONING P R S PLANS VEGETATION EAT R E -MANGROVE
COUNTER REVIEW V REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE T T
INITIALS