HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLICABLE INFO MUST BE COMPLETED:FOR APPLICATION TO BE ACCEPTED c
Date: :. : :.
Permit.Number:
Building Pelrrnit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue;Fort Pierce FL 34982
.....Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential
.PERMIT APPLICATIO.N:FOR: To Select from dropbox, click arrow at the end of,line
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PROPOSED'IMPROVEMENT LOCATION:
Address:: �® W :: r6ou iA � 131 � �i "� L 499 n
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Legal Description: i�L - v V�
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PropertyTax ID#:. L4U 2` 31,T_ 4060 .g (>pa 8 - . :Lot No.
` AA 13
Site Plan Name: R®►.r tav rr = •c� � Block No.
Project Name:
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Setbacks Front Back: ) ,S. Right Side: �.� Left Side: S I
DETAILEDDESCRIPTION O.F WORK j
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CONSTRUCTION INFORMATION:
Additional-work toe e Orme under t is permit-c ec a appy: I,
HVAC Gas Tank Gas Piping: _Shutters is Windows/Doors
Electric Plumbing aSprinklers Generator lI Roof
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Total Sq. Ft of Construction: S :Ft. of First Floor;
Cost:ofConstruction: $ �i ` ®. OO Utilities: Sewer Septic T Building Height:
OWNER/LESSEE` . :CONTRACTOR;,;
Name r.mt S
Name:
Address: tbuc ppQ �
I l b�N �
-Ave,g l wt ci State: FL Address: 31S
Zip Code:: 3 n'10 Fax: hVA City: ve v- State:. l;
Phone No. -??a 344- 2370 Zip:Code: 1 {� I Fax:-?72- .7f?l $S05,
E-Mail: elfro %&r a CL-4" .Gd4L Phone No. 772 .7st90
Fill in fee simple Title Holder on next page if different E-Mail:
from the Owner listed above) State or County License: Lc"G (h":2 M 3
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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: d
City: State: City: r; State:
Zip: Phone: Zip: !;Phone:l,
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: !' Not Applicable
Name:
Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: ''1;'
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I certify that no work or installation has commenced prior to the issuance of a permit. j
St. Lucie County makes no representation that is granting a permit will authorize the per 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 ses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resultlin your paying twice for
improvemen erty. A Notice of Commencement must be recorded aiid posted on the jobsite
befor first ' ecti ou t9tend to obtain financin Rnsult with 'I' er or an attor ey b fore
c me rk c ,dirt` ur otice of Commence ent. I`
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_S ure of Owner/Lessee ent Signature of Con�rafor/License o er
STATE OF FLORI A STATE OF FLO '�
COUNTY OF �� �— COUNTY OF —
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this/day of / 20/%.__by this L day of 2i 1'; 20 /�4 by
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2:d / •Ff��d %Misr ` 7
(Name of person acknowledging) (Name of person acknowledgirig)
Aodaal.,�
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(Signature of Nota6 Public- ate of Florida) (Signature of NotaryPublic-StCRe of Florida)
Personally Known f Personally Known I ORIIProd
Type of Identification Pr "" ••,, DOREEN J.BUFFA Type of Identificati
_.: MY COMMISSION#E 928213 MY—OMMISSIO�;FF 213a° EXPIF1� nuary3,2020 - � R�Commission No. •...•,' - Commission No. EXPIREStJa20Bonded fork UnderwritersP, on ed Thru Notary arvuriters
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION i, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW ' REVIEW
DATE
COMPLETE
INITIALS
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