HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /��J r
Date: Permit Number: A0 V 1 - L/CI
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 i/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IM.PROUEMENT LOCATION
Address: �9 0 rzj.Li�
Legal Description: C1"_U'g1-1?_ \F"V k k_WF__1� _ U� l — 164 69 407-11,
Property Tax lD#: 3��� — — X61 C� -- OCA " / Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEl'AILEI3DESCRIPTION OF WORK
&x& �1 rv��ii;�e � _�41� 36�3x a� Wk5_ 1C�
lNF--uj yCI 36SW I S I F S) N K V600 ,S06
CONSTRUCTION INFORMATION':
Additional work toe ertormed un er t is permit—c ec a appy:
11HVAC Gas Tank ❑Gas Piping Shutters F]Windows/Doors
FlElectric 0 Plumbing Sprinklers MGenerator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 500Y Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE CONTRACTOR
Name o � r[ i �l ' 11�(C�Yki 4A Name: iP7cEt1Z� ��/�SG�4"�
Address: I o Mz&w Vfz- Company: Ro wwyiceS G -yF a Tees, u�
City: CAZ,�_ rOS eCf_— Stater Address: 3761 SW
Zip Code: Fax: City: ` deT �F i,(/fkE State:_E:�-
Phone No. Zip Code: Fax:
E-Mail: Phone No. 600
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C AC_l Ss 1 6 9 15
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: 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 contlict 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 an'd 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 your Notice of Commencement.
S
NignfaMf-ui—e 'Owner/Lessee/Agent Slnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 54tTk-T COUNTY OF
The forgoing instrulnent was acknowledged before me The forgoing instrument was acknowledged before me
this::4 day of-7 20 � y this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nbtaia/Public-State of Florida) (Signature of Notary Public-State of Florida
Personally Known_OR Produced Identificatiop< Personally Known OR Produced Identification
Type of Identification Produced-VAQ; ,: L Type of Identification Produced
Commission NoJqq-'1'S(9 CO Of FloridaFloridammission No. (Seal)
ter P,�Sc,state
ffisoa FF-19M-- I
JW00
y .
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS