HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- JAN 2 1 ZUlb
Building Permit Application
PERMITTING
Planning and Development Services
St. t-��,,t� . FL
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
PROPOSED IMPROVEMENT_ LOCATION:
Address: Cf/ ,/(/,C4Hes 6/t/c ,T ns-ety We GC I
Legal Description:
Property Tax I D#: 00 — d o 7 Lot No.
Site Plan Name: �� Block No.
Project Name: / G(✓� S-)4-
Setbacks
fSetbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1'erAcve_ e,Xrs/ ,'-z7 "l le e- --P /e and+ ,.1 S-A svew
CONSTRUCTION'INFORMATION:
Additional work to be nertormed under t is permit—check a appy:
HVAC Gas Tank Fs
Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator LAIA00f
Total Sq. Ft of Construction: !�7oy 6 S . Ft.of First Floor: ��JJ
Cost of Construction:$ X10 00, O C) Utilities:nSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ave4re S-- , ai/c Name: of VV c//e,
Address:_/K /(/G7�lGS (glVal Company:_ _/�oo F fan ccs -Tic-
City: J r srov &Acl State: it'L Address: "21011 .St-u �ovte?n/--
Zip
Zip Code: Fax: City: ,OSL State:
Phone No. 77)-- 777—,�& 3 Zip Code: NQS 3 Fax: Wr zzj f
E-Mail: Phone No. 77.2-- 3{/9'-37/7
Fill in fee simple Title Holder on next page(if different E-Mail: /Loo jOcon crnfs i,/G Ae
from the Owner listed above) State or County License: CCC
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Loi eS- 1 < f -: l 4r +X. x 4F✓i � :S 4tx 1,. -:2 '�� 1 �"�Y�7 Y f 41 `��7 L t,� 1 t�.-.� l t v ti..�S � .�� x St 1 lr 1 y ti. y .: .
�SI�LEII � ITL C�NSTRUCTti7lUr LAN LAlN f1ORM ��O : , ' s' , }, .
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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 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 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.
s
_Signature of Owner/Lesse6/Agent Signature of Contractor/Li nse Holder
STATE OF FLORIDA STATE OF FLORID/Q ,�C�I
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this 0-L day of 0 20 ILO by
1kiftnQ ReTIG,
(Name of person acknowledging) (Name of person ac nowledging)
(Signature of Notary Public-State of Florida) 4((S`ig�naorheof Notary blic a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification K
Type of Identification Produced Type of Identification Produced ll QR CIQyDn cvS
U cAnSsL
Commission No. (Seal) Commission No.FFI.69 ,0II## ,
t,n ", KAITLYN LOUPE
Notary Public-State of Flori
ConlinIssion
Revised 07/15/2014 'qF°r�°a My Comm.Expires Jul 13,20 1.
Bonded through National Notary Ass i '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS