HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ✓� I -
Date:Y19�J Permit Number: I�O W'-f"! 5q(D
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: P
To Select from dro box, click arrow at the,end of line
PRQPQSED IMPROVEMrE( LOC`AT `
Address: �� al- rde
Legal Description:
Property Tax ID#:3 o-h 80-00afn-000 _5- Lot No. /a
Site Plan Name:`` ,,�� Block No. (R&
Project Name:__YVA-Jr-)-A+�- d
LLt—
Setbacks Front Back: Right Side: Left Side:
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DEfiA ED=DESi RIPTiON W0
y
A iti a wor to a er orme_ un er t is permit-c ec a appy: ; ,I
L"JHVAC _Gas Tank ❑Gas'Piping _Shutters � � Windows/Doors
Electric ❑_Plumbing ❑Sprinklers Generators ❑_Roof
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Total Sq. Ft of Construction: S Ft.of First Floor:j
Cost of Construction:$ Sift 9,0 O Utilities.
Sewer❑Septic Building Height:
OWNER/LESSEE r r�� CQNTRAs0E l
Name Ern errs _1 ota.Lo Name:� � -e
Address:,��f er�Gl fn e ECLICLY1 _n'2 Company: A r T)Ow :' )c 4 14,eaA 'lei
City 4.Sf.Lur Q- _Stater 1 Address: 5o A)1� _D I�Xi WYt>-!'
Zip Code:?M51-11 Fax: City: State: _
Phone No._1-7oZ- g0^1- (�$3 Zip Code:344 44 J Fax: -q&3-cZly
E-Mail:
Phone No.--)",7Q- 7gL- L�Ln.
Fill in fee simple Title Holder on next page(if different E-Mail a(r M
from the Owner listed above) State or County L i ense:
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If value of construction is$2560 or more,a KCORDED Notice of Commencement is required.;;)
SUPPLEMEIVT�f��QIVSTR¢¢UCTI�N�LIEt AUU��N�ORIVI�ATIi�I�&��' x � x '� �k� � ��f �`�*�� r�
DESIGNER�ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: f 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:!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 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 forany rest fictions 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 concurrercy review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessoryuses 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 withlender or an attorney before
commencing work or recording our Notice of Commencement.
s
_Signatu a of Owner/Lessee/Agent Signature of Contractor/Licen'li a Holder
STATE OF FLORIDA [' STATE OF FLORIDA
COUNTY OF t L COUNTY OF L'
The for oing instrurAent w s acknowledge#b� efore me The for oing instrument was' cknowledged before me
this day o r: 20 (_ >)y this � day of vi �' 201(.p by
(Name of person acknowledging) (Name of person acknowledd`ing)
(S'i nature of Notary P ic-State of Florida ) (Signature of Nota Public-Sta a of Florida)
Personally Known � OR Produced Identification Personally Known e;,"' OR Produced Identification
Type of Identification Produced— Type of Identification Prodi tcld--
; CHIS INE A JORDAN ;� °4 CHRISTIf�,a�JORDAN
Commission No. ?'% a Commission No.— ;�• �''cc
�� MY O� ISSION#FF235578 COMMI SION#FF235578
AM, EXPIRES July 31,2019 EXPIRES July 31.2019
a _�__•_ _ r .n n• �- N4/1��bf%4��� FMxdruVa:aryServu:aron•
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
INITIALS
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