HomeMy WebLinkAboutBuilding Permit Application i;
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1'I boa ^N o
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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: Window/door 'll
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PROPOSED IMPROVEMENT LOCATION: `
Address: '*7 000 A94&u tS RA (46 wooJI
Legal Description: k 41.&OPO4 3?6l� - yni4 11�OLK I (a 1 444% / gr•ol 12- 4-&Sf 5'40 E± Ot"
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Property Tax ID#: Lot No.
Site Plan Name: i1 Block No.
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Project Name:
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Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'wo �y/�t l�or d'virS ,
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all that appy: ffWindows/Doors
aHVAC GasTank Gas Piping Shutters
Electric 0 Plumbing Sprinklers 1:1 Generator E] Roof
Total Sq. Ft of Construction: S Ft.of First Floor: i
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Cost of Construction:$ 1Tnn� Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR';
Name "v0. is Name:
jtJACD &St"Alpxl�I 06k torp
Address: 'I"1y ( 4 lei`i�PM Tr s�e 1 Company: tG q "
City:_L&5'+ ►���w� 1b@GG State: Address: l' Gl AW o `�t �c 3
Zip Code: Fax: City: er�s`�'Lu4ti\,L I Stater
Phone No. gl3_ 32.1 Zip Code:_'5ggfr(a !;, Fax: 91L 3*3 1(
E-Mail: Phone No.77 Z A� :'33 L 3
Fill in fee simple Title Holder on next page(if different E-Mail:Qi&(DWro(D RICLCZ Re -%&4 l &ti1 0Qrpdor4
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: . _Not Applicable
Name: Name:
Address: Address:
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City: State: City: I 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: E
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 Amendm =nts.
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 fl t inspection. If you intend to obtain financing, consult wi nder o'r an attorney before
commend rk recordin our Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA. 1 STATE OF FLORIJnA
COUNTY OF COUNTY OFA
The forgoing instru„ nt was acknowledgegefore me The forgoing instr ent was acknowledged before me
this 2_1 day of 20 by this day ofUkr'(J ,20 G by
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(Nam of person acknowledging) (Name ofperson acknowledging)
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(Sign ure of Notary Public-State of Florida) (Sign ture of Notary Public-State of Florida)
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Personally Known _OR roduced Identification Personally Known OR Produced Identification
Type of Identification Produce Identificatio Pr u ed
J Alur,er;'il ,
otary Public S1,u, i i N"" J
;�,;� gas, S2 IE O'i3ONr�uk
Commission No. _ $ea� �N,4� 'ssion No. Not�r
Commission # FF 94 403
.ri Y u he-State of Flunda
My Comm.Expires Jan : 2020 • Commission#FF 947403
OF f�P ^ R
ug a lanai:VII&V assn. ;AFF,, ❑es an 3,2020
Bonded through National Notary Assn.
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW !, REVIEW REVIEW
DATE
COMPLETE
INITIALS
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