HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 ^(� 1 n
Date: 2IZi I , J� Permit Number: Lp\ )
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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
;PROP,OSED IMPROVEMENT LOCATION ',:
Address: 1505 h W Te_(z a\f Ot�V-q SL-19.1b
Legal Description: _ F L1lk7 a -.FvqsTt km M D c-K Villott
Property Tax ID#: HL-f'210, ft l X l• )l - b o - Lot No.
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Site Plan Name: 15 t-W C_Pff1 ' rr Block No.
Project Name: �I_V-ro Ll , Y id A � �
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESyCRIPTIONDF WORK
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CONSTRUCTION.INFORMATION
itiona I work to be nerformed under this permit-check all tnt appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
FlElectric 0 Plumbing ]Sprinklers E Generator 11 Roof
Total Sq. Ft of Construction: 1I122 t, S . Ft.of First Floor:
Cost of Construction: 7,`ll l ;J�.' Utilities: SewerElSeptic Building Height: S `
'OWNER/LESSEE '`" `.CONTRACTOR: '
....:.......
Name fYlU-,rrmq1`7(�U Name: .Fk-L Y1 V-)-Q-e r g
Address: )50S L_0iln0,Q..0W T-Pf Company:%'Ner-�Cc -RMm net, wrr+ E rsv,
City: J)CL-�M 1�1 c+-L( State: F-L Address: `KplZ 5 `b4E- PlY
Zip Code:3Fax: City: Q,,YWOL QCk. Stater
Phone No. Zip Code: 33g0_1 Fax:_q 1 01 -OS7&
E-Mail: Phone No. J- -6u'-f- W SI
Fill in fee simple Title Holder on next page(if different E-Mail: tri�00icd,, &00,e , Coq^ Ucor0o"
from the Owner listed above) State or County License: L-ilD10-S
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C�NSTRUCTIO'N LIEN"LAW�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 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 yoA intend to obtain financing, consult w' h lender or an attorney before
commencing work or rKording your Notice of Commencement.
s
aiature o Owner/Le ee/ gent S' nature of Contractor/License Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF M COUNTY OF TlfatY_M
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of `'C,0A V 5An 201 S by this 2l day of 1� 20 _I'S by
(Name of person ackn edging) (Name f per on ac wledging)
1 �
(Signature of Not r ubli/c-State of Florida) (Signature of N64 Public-State of Florida)
Personally o V OR Produced Identification Personally Know lyes
Type of Id ti o;pg tion r ry e Type of Identific 'o uctp p
�i Nota PuW c stela of Florida Liah Joslin
Liah Joslin Commission No. Mr Commhwoe Ff�� s
Commissio FF 180f�gal) .�7JOWO tY
o�p Expirera 1?102/2078
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS