HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t
Date:��1q��� Permit Number:
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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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line w•`��o w pyo
RROP.OSED tN(PRQUEMENT LOCATION
Address: P1 $ Dct-x� IN— 7(8 !3
Legal Description: hi',Lhw'r'S c",.-j. 1?(,06 1? yti i r 71813 Uo Ag tll1P S// ,
Property Tax ID#: gJ-0 Z —803"CX6f- CDO— Lot No.
Site Plan Name: /110/t&/ so^) Block No.
Project Name: moe& 'l Sd
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
W I N(00A ACQVkW
CONSTRUCTION INFORMATIONh
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Additional work to be nertormed under t ispermit—check a app y:
HVAC Gas Tank Gas Piping _Shutters I]Windows/Doors
1-1 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
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Cost of Construction:$ c`�L1oO Utilities: _Sewer O Septic Building Height:
RILES It6, CINTRACTOR s
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Name Name: 1 /^i
Address: 3 deet -k STS Companyla6m �T/ 1"A140''Wo"
City: " (k0S59 State: VJ� Address: /7Zo IVAI Hwy
Zip Code: SH 16 0 1 Fax: City: '�; 4;.-- State: r-t_
Phone No. -8 Zip Code: 3c4C!91f Fax: ('1z —9744
E-Mail: Phone No._ jl� ^1 2— 004 O
Fill in fee simple Title Holder on next page(if different E-Mail: #"-O- 0Y-W o0•
from the Owner listed above) State or County License: G 6'C MOS Y S:7=
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTIQN LIEN LA1N INFORMATIQN
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 5tZ No"A- Name:
Address: rl ani SJiTeM Address:
City: State:_ City: State:
Zip: X7(2_Phone: -- Mr 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 andreview 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:Y r failure to Record a Notice of Commencement may result in your paying twice for
improvements to yo p perty. A Notice of Commencement must be recorded and posted on the jobsite
before the first i nsl c •on. I you intend to obtain financing, consul wit led or an attorney before
commepeinkwor or ecoyd g your Notice of Commencemen
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nature of Owner/Lesge Agent Signature of Contractor/License Holder \
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST COUNTY OF S7–
Th
TThe for ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi day of �� 20/ by this4§ay of ��f� 20 / by
(Name of person acknowledging) (Name of person acknowledging)
(Signat e-of Notary Public-Stated Florida) (Signatu of Notary Pub ic-State o Florida)
Personally Known_i,,"' OR Produced Identification Personally Known 1/OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,.•'�iriS''., CtAUMOND I Commission No. ":��P'•.
qUMOND
:= MY MMISSION Y FF 173907 '• MY COMMISSION N FF 173907
ts'• r EXPIRES:December 7,2018 ` P, EXP
f,„ ",g 1••• Bonded Thru Notary Pobl a Unde carders
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS