HomeMy WebLinkAboutBuilding Permit Application .a
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED // _
Date: �� 1�D Permit Number: �(Q �
Building Permit Application MAR 2 1 2m
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: O
Legal Description: lAya r buic IA-+ 21 4,0± t
Property Tax ID#:.�sHL-i 7.'L- 'R 15 • OmLo -I OU - 2 Lot No.
Site Plan Name: L_t.A_ -kA Yl!� Block No.
Project Name:
Setbacks Front 1� Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF„WARK
'�,,��lo•C+itn� C� Ilcfc$ sc Lt toxo Q_-'Arwl E o oars .
CONSTRUCTION'IN FORMATION
Additional work
,toe nertormedd under this permit-check a appy:
HVAC 0 Gas Tank ❑Gas Piping 0 Shutters Q Windows/Doors
11 Electric 0 Plumbing []Sprinklers 0 Generator E]Roof
Total Sq. Ft of Construction:A-Ci a Sq. Ft.of First Floor: 1 -
Cost of Construction:$ 22. LA •Qty Utilities:El_Sewer E]Septic Building Height:
OWNER/LESSEE CONTRACTOR.
Name Q_%LL iVA:J Jdwr1 Name: J .x r&A
Address: ~1OL4 W iYA+CrS C`y-4j_%4 TL CL Company:%AV ef_;dA6n ?041h &IMO-k Ca&r4s4 Oae
City: 94&t� C i+`� State: �- Address: 7, l S4 1�d:G�n ST
Zip Code: 3q 19 0 Fax: City: Q-kUAr+ State:_J7__t-
Phone No. Zip Code: 34¢4 of "1 Fax:_L41 C�-01”(o
E-Mail: Phone No. Ub-45(d(o
Fill in fee simple Title Holder on next page(if different E-Mail:AM&f6an:fg Aaran E Doc, (92 L(Ahw-
from the Owner listed above) State or County License:`. L-f�C L* s
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
- •ti
SUPPLEMENTALCONSTRUCTION1LI-EN LAW INFORMATION
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 mbkes 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 pos d on the jobsite
before the first i ection. If yo int to obtain financing, consult with lender or an rney before
commencingworkor rec r in o N ti
of Commencement.
S
JSi nature of Owner/Lesse /Agen Sigfigfure of Con ractor/Licen Holder
STATE OF FLORID STATE OF FLORIDA
C�
COUNTY OF l COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of °(A ABY C y 20 � Ll this 2 day of fI�YC ,20 Un by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of N ry Public-State of Florida) (Sign ure of Nota ublic-State of Florida)
Personall < r e cation Personall Kno �� r ntificatiori
Type of I e t }r,@, °nPr0S9i state fiori Type ti icat�oosry U 1.49 �i�g�c�e et
Ra bah Joslin r° Liah Joslin
Commis ^8� My commission FF leoso(�Seal) Com i commission FF lsosos eal),
%afn xpir2s 1 210 2/2 0 1 8 •Expir9s•12102 t
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS