HomeMy WebLinkAboutBuilding Permit Application I
I�
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c�I11 l l�� Permit Number: �' 0 na
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 X
PERMIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: elvd, B�a , 1 _
Legal Description:ee�4kS )slacid Inc 6 C o�ndb -Serino�l 11 Parcel 14�1 9 �c�rr�-cCt�Q
/A CX' �n ari
Property Tax ID#: L1569 -5b 1-O t"�5-000-I I Lot No.
Site Plan Name: Block No.
Project Name:
I
Setbacks Front Back: Right Side: Left Side:
II
DETAILED DESCRIPTION OF WORK: F
ear o4 P, FOO
CONSTRUCTION INFORMATION: 5
Additional work to be nertormed under this permit-check all appy: i
I
_
HVAC _Gas Tank Gas Piping Shutters Windows/Doors
a /
Electric ElPlumbingSprinklers Generator 'JRoof
Total Sq. Ft of Construction: S . Ft. of First Floor: "I
Cost of Construction:$ �.( Utilities. —Sewer _Septic i Building Height:
I
OWNER/LESSEE: CONTRACTORIi
Name i h Name: aJl-P
Address: e; && Company: li
City: State: J_ Address: �29a f �• US11111)(1)
Zip Code: Ztkcl,5� Fax: City: 1�1�j e�C� State:,
Phone No. Zip Code: '�L Q99 Fax: 17,-Y6y-/0(000
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: '
from the Owner listed above) State or gunty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�I
I
SUPPLEMENTAL CONSTRUCTION LIEN" LAW INFORMATION: },?'
I'.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ; _Not Applicable
Name: Name:
Address: Address: II
City: State: City: I. State:
Zip: Phone: Zip: Phone: I'
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: I. 1
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 holderlto 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 uises 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 an;d posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comme ci work or recoldingVour NSake of Commencement. !,
s
_ ture of Owner/Lessee/Agent Sig at of Contractor/Licens`e Holder
II '
STATE OF FLORIDA 1 STATE OF FLOR
COUNTY OF COUNTY OF
The Qrgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this N'\ day of_&A A4 �7� , 20��by thisday of /i ,20 by
'I I
�II.
(Name of person ackn t (Name of person ackri'owled'i% ' p..,• i
:ot,.....,� •. SONIA DESTAFNEY aL, SONIA DESTAFNE
:
MY COMMISSION#FF125420 =,'i' MY COMMISSION#FF12542
EXPIRES May 21, 2018 EXPIRES May 21, 201
•„ OF rM1,:
ignatue o Notary P 13 b33M1LrDf Flc5ipdWqNotayService.com ign ture of N to Public-S•ti �(Prorida Ioridallotaryservice.com
I
Personally Known l/ OR Produced Identification Personally Known 1' OR1Produced Identification
Type of Identification Produced Type of Identification'Produced
Commission No. (Seal) Commission No. (Seal)
it
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I'
COMPLETE I!
INITIALS I
I, I