HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO)MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^�
Date: `! I r (J Permit Number:
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:
PR4P��_SED 1NI�PR0�1/EI�I�$NT L=®CA�(�N: : j _A
Address: ® �JAI S OCP�lrl �(/nnnn/: �� J_ef? -e17 ,(leach ,/� - YY
FS-7
Legal Description: Q� Or UO yPy%5_03?�! 1429 —//37� d31, /'/ z�9�'
?
Property Tax ID#: Y 5-�t/ -31I ` 00✓ �' 00n �� Lot No. 62
Site Plan Name: U'e'/ 1'-' e l�Ul--hol' Block No.
Project Name:/3 2 I/e q A//le
Setbacks Front Back: Right Side: Left Side:
' ,I' ER ®ESCRI' TI®',N OF VIIORK:
CQr>7�J/e �`e
ale^9 :1:D✓) a,*?A" rehv0Ira/ a76 7V s�. f
done
G®NwSTRtU�CTI�C}N FN.F®-Ri1J1�AT(®N: . .
Additional work toe e orme under this permit—check a appy:
HVAC Ei Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
1-1 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Z7 57 Sq. Ft.of First Floor: 71
Cost of Construction:$ 1900-00 Utilities: 1A I Sewer 11 Septic Building Height: �' f
®U1/NER/LESSEE• �� C®NTRACT®R:
Name C�g,-IeS In 5 Wr- d-Eh , S Name: IfZaw ; A4n
Address: WO 5f- Cen7M WG t�yL Company: / 442 Y,iV Z74 ,�0 � J✓r• bg-
City: State: FA Address' �I .✓1� ... ���/J60- ,57�-
Zi Code ` ' -rte
p `3y'� y Fa is City:: : U�/'1:f@a ° pP.l,�f� State: L.
Phone No;.. 3.0.2 ��//-3979 zip Code ' 3y9�'. Fax: 77:2.2-3.2- Ili 91
.. .;, .
E-Mail-.-".. Phone No. 7 0 375
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S't1PPLEMRITAI C®NSTRU�I®N LIEN IOW IN�FORFMATI®N:
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 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 gr re_cording our a of Commencement.
s
_Signatu a of Owner/Lessee/Agent 'Signature of Contractor/License Holder
STATEOFFLCOUNTY OF COUNTY
ORIDA
COUNTY OF
The fgrgoing instrument was acknowledg d before me The forgoing instr ment was acknowledged before me
this l day of `� 20by this day of �'� Jlfby
Ackarn
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Prod ced Identifi ation °� Personally Known OR Prod ed nti ation
Type of Identification Produced L,��— ~Co Type of Identification Produced
— —
Commission No. C (Sal) Commission No. ( (Seal)
t�R KIMBERLY A.WAL R
KIMBERLY A.WALKER
NOTARY RUE11 1C _11MAn-
c SNOTARY PUBLIC
Revised 07/15/2014 STATE OF FLORIDA a STATE OF FLORIDA
E--ires 3/18/201e Camm#FF089371 Camm#FF089371
'WCEW Expires 311812018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS