HomeMy WebLinkAboutBuilding Permit Application IV a.-,V,3r r;rot
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1
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: To Select from dropbox, click arrow at the end of line
PROPOSED 1NtMOVE MENT U CATION 4
Address: 5V)49 —t- e r —JA 0r r I —T ;e ••�� { ��-- 3 ��-S"f
Legal Description: 6rv>V Lam.. ��CC i). tic,-t. J✓L4
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PropertyTaxlD#: I`f0� _too( -000ft _ 000 - O ! Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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C t jjtST,RIONINFORMATION F 0� f 4
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Additional work toe e orme under this permit-c ec a apply: f
HVAC E]Gas Tank ❑Gas Piping _Shutters i Windows/Doors
❑
❑Electric a_Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S . Ft.of First Floor: ,I
Cost of Construction:$ dad • Oy UtilitieS: Sewer[]Septic I, Building Height:
O NERLESSEE� F } CONTR1 ka #R• µ w
Name Gee to L') Name: t('tult
Address:__1-1 -R-in 'L>✓ /-r Company: ANN
City: 'P1 e State:_�' Address: 4M &Aff*fftble Plumbing
Zip Code: 231{g 51 Fax: City: M SE 3 Avenue State:
rL 334811
Phone No. Zip Code: '9 Faiovaid x: qSN 4 a a`fit t)al
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: r�- •Co W"
from the Owner listed above) State or County License: en, 579C)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required:)
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:. _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: ,Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 or recording our Notice of Commencement.
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su_� s
_Signature of Owner/Lessee/Agent Signature f ontractor Licen ie Holder
STATE OF FLORIDA STATE OF FLO"
COUNTY OF 5+ ���� c COUNTYOF \ e---i
The foToing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this v day ofr��= 20i by this V6 day of F� ��r�iL 2010 by
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(Name of person knowledging) (Name of person ackn w ging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Pr Type of Identification Produced
1oaY Pu Notary Public State of Florida
Commission No. williarr(SB-akomas Commission No. F_,011 ��� Notary Publiq�Ptgi4f Florida
C ( �" My Commission FF 008234 . !lC0 R o M Commission FF 008234
ofExpires 04/15/2017o o�� Expires 04/15/2017
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW I REVIEW REVIEW
DATE
COMPLETE
INITIALS
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