HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
"INFO
1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2�, 1 tY Permit Number:_!100
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 2( _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3��� kypoy\s oad Owt, `
Legal Description: SQ U`CkY)a ) 1 Pl� TnYe-e.. - -1) 2 JAY
Property Tax ID#: �5ql'S_- D Q J Q-3(o I- 000 "y Lot No.
Site Plan Name: Block No.
Project Name: S'-kMs
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: b.J�Q1rj� Q -�
T o -�1*'-e)C►s tIoC .U�k , r e.oa;�
( S�SA 0�_u Yt ick!?, 1 rY`LW S K 1
41 v?, 0V c- Tkt-o,l LA.hn UpZ
L s- 1-, l 16a-z- Owen4_o-N rg IR,(0(a H . I
CONSTRUCTION INFORMATION:
Acid itiona I work to be nertormed under tispermit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑_Plumbing ❑Sprinklers Generator _Roof
Total Sq. Ft of Construction: ►2-W S . Ft. of First Floor: �l (40b
Cost of Construction:$ tl �(�y Utilities:nSewerL-1Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Y CXA Name:
Address: 9 -M kxaO�dCompany: l
-c�,
ti
City: R fk cl�ux_ez�) State: Address: 3i1( 5 AAs k4
Zip Code:aAaSc:)- Fax: City: ROLM
State:
Phone No.---n-;)- 'K" Zip Code: '3gC1 X2 Fax: '1')Z q(o W (Ota C)
E-Mail: Phone No. X12- L4 -CO v
Fill in fee simple Title Holder on next page(if different E-Mail:J�OrI l a@ at[ayear-go og) -Cbm
from the Owner listed above) State or County License: C�C la�Z(.1 I"l�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: 3el_Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ZNot 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 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
comm"cing work or recording our Notice of Commencement.
s
Ignatu're of Owner/Lessee/Agent Signa a of ontract /License Holder
STATE OF FLORIDA STATE OF FLORIDA r C
COUNTY OF COUNTY OF l -
The forgoing instr�Vmer)�tA�was acknowledged before me The forgoing instru ent was acknowledged before me
this_Uday of `�� 20L-6-by this» day of 20 L J_by
F'iKLAL TIC= EDIESTAFN EY
o �.
(Name of person ac k i0ti i:.':) (Name of person acknowlec): i: ) MY COMMISSION#FF125420
MY COMMISSION#FF125420
'•', "oFFo?' EXPIRES May 21, 2018 `""Op o., EXPIRES May 21, 2018
'407)398.0153 FloridallotaryService.com
(407)398-0153 FloridallotaryService.com
S(S�'
at re of otary Publ
ic Stto of Florida)
QSi' f otary Public-St of Florida)
Personally Known n/ roduced Identification Personally n OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS