HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .21,25 L,201(0 Permit Number: (SC�
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
PERMIT APPLICATION FOR: Window/door
{ R POSED, MPRQVEM NT .QCATIQI�I
Address:43 1 l q &t4lLue_
Legal Description: _SUA Ci Ec rL 5R - /)o ( 1�\ K- Ll (,J 2-1 o� LDA- Q
L_o_� j0 as &C_) ((DR- :Z_3.$)
Property Tax ID#: r-2 Ll 0,'�-- 5Q OOrr0- ,)CO I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE,CR)PTIONOF WORK
X1
CC?`NSTRUCTICIN„tNt3RMAT�QN r a.
Additional work toe oerforme under this permit-check all appy:
HVAC Gas Tank []Gas Piping In Shutters windows/Doors
11 Electric 0 Plumbing Sprinklers OGenerator F] Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ /� �.�� LitilitiestSewer Septic Building Height:
OWNER/LESSEE ; 7'€ s , r CONTRACTOR
Name � ham;Fer �J Name: i ecu-M
Address: 7 q q SLA-) (_i, c!A �(- Company:
City: LucirL State: Address: �O o o25 e1
Zip Code: 3y C �3 Fax: City: t% v{n State: �L
Phone No. ? Zip Code: 351%( Fax:
E-Mail: Phone No. -L-tZ) 40T- q5V
Fill in fee simple Title Holder on next page(if different E-Mail: ✓�{'o cr� S ct,ccQvuor�-4�.c�+�
from the Owner listed above) State or County License: ('cc I Sa 0O(90
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C�
ONSTRUCTIQN LIEN LAIN INEQ�N1ATIaN n
k..i
ps
DESIGNER/ENGINEER: ✓Not Applicable MORTGAGE COMPANY: , Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: LAot 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 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 our Notice of Commencement.
s
_Signature of wner/Lessee/Agent Signature of Conf actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA o
COUNTY OF yv�aG . ll��� COUNTY OF f v�.��611, &u-V
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,5;:7-5 day of FeJo 0C4\ 20 f�_by this o2�day of & 20 L by
egvlk
(Name of person acknowledging) (Name of person acknowledging)
(Sig ature of Notary Public-State of Florida) (Sinature of Notary Public-State of Florida)
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dS�
Personally Known �r33uPersonally Known*'..'
WMDJM
Type of Identification Pro Type of IdentificatNOTARY PUBUC
Awl STATE OF FLORIDA
Commission No. QU1 eaW Commission No. FFiNG10
al IM QNOMM �d xpires 1/2812019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS