HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLIC' BLEJINF/O' MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (��
Date: 2? ! b Permit Number:`•` `l
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 t
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �/�✓//
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PERMIT-APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 00 lV e4IC= (a 4AI 19
Legal Description: Lok log 0F lkli�cr�� Pi�le� S�Q��v�Slc✓1 -I' q&r_
Property Tax ID#: .13 2.-S00 -olook -000) - Lot No.
Site Plan Name: Block No.
Project Name: 30c- G� -FC?0 C�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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rMil t'- 6 I 6-4 aA - r all q0 �' C P c am oc SGri
49!'N(t 6 rOr e,-,, m�� SiG�( G$ e�SlN• 4.�-� 5.
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit-check all tha appy:
HVAC 0 Gas Tank ❑Gas Piping 1:1_Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 1 GCJ Utilities:Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �Tr)se.L, Name: r,
Address: -OC6 f-'f'fl e-- OV`• Company: e)o"S
City: FA r e 1—LP_ State:EL, Address: 7%M'( 1V• 1� /'SCA 6r-
Zip Code: I Fax: City: I-le-rp Qeork\ State:��
Phone No. S__��1 ^�0( C3- Zip Code:Z2q(/, / Fax:
E-Mail:,,<L -S W�9� ;rJ maty 1 • CtI� Phone No.-772- 321-"75-2-6'
Fill in fee simple Title Holder on next page(if different E-Mail: �(Cn� c�3®C'W►G% Crir^
from the Owner listed above) State or County License: a�S�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DE*SIGNER/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 theprmit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or anscovenants 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 Code's 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 your Notice of Commencement.
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Signature of Owner/Lessee/Agent Sig re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLQRIDA
COUNTY OF ..J COUNTY OF XP<V%Zk
The for oing instrument was acknowledgqq before me The forg in instrunlent was acknowledgep pefore me
!Ma' of, N - J,,g
tl y J=AAAk&_P�� 20 Ubv this ayVf-,-J/1?)V1AkfA/V. 20 (1(0 by
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(Name of person acknowle (Name of person acknowiedg—oin .
(Signature of Notal5ubli ' ate of FIbrida (Signature of Notary State Floridh
Personally Known XOR Produced Identification Personally Known 7011 4 Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 1111119WOLUNDEEN Commission No. LUNDEEN
MY COMMISSION#EE192669
MY COMMISSION#EE192669
-S,APO 95 2016
- EXPIRES A;d W 25,2016 -EXPIRE P (407)398-0153
Revised 07/15/201 ,•7)4348.0153 FWiftN0t3WJM1M.=n
REVIEWS FRONT ZONING SUPERVISOR' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS