HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:_ d(00�-
Building Permit Application RECEIVED
Planning and Development Services FEBq �o��
Building and Code Regulation Division FEB 0
2300 Virginia Avenue,Fort Pierce FL 34982 1l
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential n
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCATION
Address: Io7ot 5 ocenw -P/-
Legal Description: TcENToa.0 C"T - SE�•rom G 1-c?' $(., (o& Szo
21
Property Tax ID#: y3`l( - °8D� -r»�� -cow ` S Lot No.
Site Plan Name: 601210FEN Block No.
Project Name: G ILIP1%s:�
Setbacks Frontt�'W Back: Right Side: N JA- Left Side: '
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DETAILED DESCRIPTION OF WORK �
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CONSTRUCTIFON INFORMATION
Additional work to be nertormed under t ispermit-check all ViU appy:
1_1HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ �a0^ Utilities: _Sewer O Septic Building Height:
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OWNER/LESS.EE _ . . „ IiN
CONTRACTQR r
Name =Q eat r„:;,e:LNl Name:
Address: 18-10( S ODM %a2 Company: 7Y5ggaj ��-ri� T!/r l�li.✓usq
City: -Ta sm State: r2 Address: /Il`I/
Zip Code: 34"ll S”7 Fax: City: s�r/R^1?� State: PL_
Phone No. Zip Code: l 4 Fax: G f 2
E-Mail: V1t7YLl I%PEN(SBS_ en rNWPr1[_' C W-1 Phone No. 2 oW
Fill in fee simple Title Holder on next page(if different E-Mail: Ni�/ �,��✓mow t/ •`'�`ti
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL Ct?NSTRUCTIQN LCEN LA1lV INF .RMATION
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 failur to Record a Notice of Commencement may result in your paying twice for
improvements to your proper y. otice of Commencement must be recorded and posted on the jobsite
before the first inspection. I intend to obtain financing, consult with lender n attorney before
commencin or r co i our Notice of Commencement.
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_Signatur of Owner/Lesse ent igna re of Contractor/ icense Holder
STATE COUNTOY OFORIDA �� rlf COUNTY OFSTATE OF ORIDA �-/�
The forgAing instru e%t was acknowledged before me The forgoing instrum n was acknowledged before me
this day of -1)24090' 20&by this day of � 20 /& by
by
(Name of a on a wledging) (Name o p rson acknowledging)
( gnature of No ary Public- ate of Flo ' a) ignature o otary Publi tate of Flo a)
Person Know OR Produced an
onally Kno n OR Produced I ntification
Type of Identification Produced Type o e ification Produced
Commission No. (SM LEE TINNEY Commission No.
Notary Public-State o1 Florida ;2o+R'P off•, JOHN LEE TINNEY
+ •�= NotaryPublic
J My Comm. My Comm.Expires Nov 15,
Revised 07/15/20 %'F dr;��� Commission#FF 165316 p 2018
' °CF``' Bonded through National Notary Assn �'�,FOFF�°;.�� Commission#FF 165316
"• • Bondedthrou h
NationaiNot
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE .
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS