HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ln�
Date: '21" Permit Number:
Building Permit Application JAN �0
Planning and Development Services m
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 v/
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`IMP.ROVEMENT LOCATION:
Address: `]J® 1 '?Ads` e6- A�je FP- f k-AA meM
Legal Description: L44WW9 �A`14- UAtT `l - 1tt1_ 3�J (.4?-1 zMA-A 136 1H) DQ
�i2& - 6T?1 ; iIKS- I'tIt
Property Tax ID#: I ZDI - bolt- 0 aM_04b-q Lot No. I (o
Site Plan Name: Block No.
Project Name: `t'c a�!PwA,
Setbacks Front Back: Right Side: Left Side:
,. RIPTION &c .c .rry;'a.v;v. ,,�':Fess.✓-_ y;.Y ,� .,_,=- q..,m 7*.c..__... ah:,; de:- :�.-,-... :.,; i1 _..rrc J ,r•':'. .:.,: .
DETAILED DESCWORK.
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CONSTRUCTION-INFORMATION: '
Acid itiona I work to be performed under t ispermit-check a appy:
HVAC Gas Tank 0Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing OSprinklers [Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ a./;l T3.66 Utilities:Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name &b&Aa T Ao u6 54 y Name:
Address: 736 ( ipA&9-`d. A4te Company: &OA-la-4 6 Awl- �e,lr�dtc5
City: 'FCk?- ?1&0.44- State: R, Address: PU. S, pAA4 Aw
Zip Code: "54161 Fax: City: t1fLT-ggigCWL— State:--EZ
Phone No. -7-7A_ ��5" 1� `'�H Zip Code: 3-Z'714 Fax: 321-2. Y - 63198
E-Mail: Phone No. '_;?-I- ASLS- T It L(o
Fill in fee simple Title Holder on next page(if different E-Mai1:Qattt_-( eWAfcAS<4, WEy&S &CA
from the Owner listed above) State or County License: CARL (34d(4'03
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�SUPPLEMENTAL;CONSTRUCTION -LIE,N 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 erty.A Notice of Commencement must be record d and posted on the jobsite
before the fir5t ' io . If you intend to obtain financing, consult w' �rlr or an attorney before
commencin r r ordin our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Sig an ture of Contractor/License Holder
STATE OF FLORIDA - 77z STATE OF FLORIDA
COUNTY OF COUNTY OF 02 T/�`/
V a)
The f ing ins ment was acknowledged befor `� The or
piing instrument was acknowledg d before me
this day 20&by `° �o c this . day of 20 �by
2 9li�
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Cn F r
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(Name of person acknowledging) �;_ (Name of person acknowledging)
av�=64N'
S �N
Fo'
(Signature of Not ry Public-State of lorida) / (Sig o Notary Pu Ic-State of Florida)
Personally Known OR Pro d Iden tification V Personally Knowny OR Produced Identification
Type of Identification Produced _ % �' ` Type of Identification Produced
Commission No. (Seal) Commission No. JEANET(MDANIELLEVOGEL
MY COMMISSION#FF114946
EXPIPPS;April 21 9 JA
Revised 07/15/2014 (407)398-0153 FloddallotaryService.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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INITIALS