HomeMy WebLinkAboutBuilding Permit Application ALL APPL CA LE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED
Date: \'I'v Permit Number: `�0
RECEIVED 'n�1041015
Building rPermI Application RE�E��,-D JA!-] 0 g.Lvr,7.
�
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 A—
PERMIT APPLICATION FOR:. To Select from dropbox, click arrow at the end of line
-PROPOSED IMPROVEMENT LOCATION: II
.Address:_ Q�o� S�n'e-(W o 1-n -�OA i-evve, -0,
Legal Description:: Y4 I LA LA
Property Tax ID#: 0 1 Lot No.
Site:Plan:Name: \ \ Block No.
Project.Name: '�Ot-'V
Setbacks Front Back: Right Side: Left Side:
FDETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to. e e orme under ififf permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers E Generator _Roof
Total Sq..Ft of Construction: S :.Ft.of First Floor:
Cost of Construction:$ A R`�� UtilitiesInSewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: ► 2
Address: Company:
City: <A State: Address: 261 S x.J
Zip Code:-J! SS&q Fax: City: P Sa State:
..Phone-No. -'7Q- 3 � ��i3b Zip Code:
E-Mail: Phone No. -)3-1 ^SQ5R- J$iD(o
Fill in fee simple Title Holder on next page(if different E-Mail: - 'e-
from
efrom the Owner:listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 Commencementt be recorded and posted on the jobsite
before the-first inspection. If you intend to obtain financing, con nder or-an attorney before
comm work or recording our Notice of Comme ment.
atu o Owner/Lessee/Agent Signature c icense Hol e
ST/F'FF OF FL RIDA STATE OF ID. L uC aQ
COUNTY COUNTY OF ��
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this:�\_day of _3'q YN 20 IS-by this'L� day of tc% 20 I6 by
a )c,h V�e cjie {' -:Sb L,.vim, 44 114 'A e
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubW State of Florida) (Signature of Notary Publ -State of Florida)
� ENS rida
Personally Known i2 rodu��� A1ggAlyd Personally Known OR-Pro uce ion
Type of Identifica iorl?t�de�d ��' 16.20 ° Type of Identification Produced,
omm. EE 65876 N01d1Y ruullu
fres
Commission No. ` `r ?< _�coCmm�` �na �ona1 Notary pssn � Commission No. 5� J MyCo � n E
Bonded Thtcu 3 .: i ^' _ _
9onded Through Natior ;n a
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER -REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS