HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: QA eo $ 201s Permit Number: I60 I Ld�
RECEIVHD AN 2
,J =r
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 _Y__ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line tSG C5 _
PROPOSED IMPROIIEMEIVT LOCATION
Address: 10(Q00 02
Legal Description: 06C/aNA 4,Q&m� Cc*Jorn IJP Un,tT 100l A-^,0 V^-QI V 57b�� /A)
Property Tax ID#: � -��c�g S - tact-/ Lot No.
Site Plan Name: l s, l� A- Block No.
Project Name: C-U
Setbacks Front Back:�Right Side: Left Side: ti
DETAILED DESCRIPTION.OF 1N00K
a3 g9-� F t y
CONSTRUCT)QN'I NEORIUTATIO N
Additionalworlktobe nertormed under this permit-check aappy:
❑HVAC Gas Tank Gas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ ��, (!70 Utilities: _Sewer Septic Building Height:
-0 WNER/.LESSEE CONTRA=CTOR:
: „
Name Name: C_ G✓�
Address: O _ i�Le Company:
City: TLWS&-.i 130%2+ State:_Eti Address: ff?A
Zip Code: 3 q al S 7 Fax: City: . State: 1Z
Phone No. 209- YS Y- Y0-7!:f Zip Code: '7WSy Fax: 69Z-477yy
E-Mail: Phone No. (f - 0074a /�
Fill in fee simple Title Holder on next page(if different E-Mail: Bei (; .GJti
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCQNSTRUCTIN LIE° J LAIN INFRMAIaW
a . �. .
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 p'ermit 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 p oper . Notice of Commencement must be recorded and 1posted on the jobsite
before the first' spect' n. Intend to obtain financing, consult with nd or n a orney before
commenci rk or ec i our Notice of Commencement.
S
_Sign re of Owner/Less /Agent Signature of Contractor/License Ho er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �S>— f ( fes COUNTY OF QST f Cy_-//_d�—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiay of S� � 20/ by thiay of 20/yam by
(Name of person acknowledging) (Name of person acknowledging)
(Signa of-Notary Public-State of Florida) (Signa of Notary Public-State ofTForida)
Personally Known r//OR Produced Identification Personally Known 1'1/tate—o011
/OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. I,•'ti Y'f''''., ANI>s_4%UMOND Commission No. "'�Py'% fel GAUMOND
MY LOOMMIMILM 0 FF 173907 MY_
EXPIRES:December 7,2018 'ended ThFu Wiry Public ndopurhers :, `• E P RES:ISSION December 7173907,2018
,R���°,•• Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS