HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - �v 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: To Select from dropbox, click arrow at the end of line
Q'
k:..
PRC)�POSED IAT'
:PROUEMEN
Address: 9;�2 S S /�CCA l�� /
Legal Description: 0116141 &�f yf If-f Zvei•e G •/7 Z07 1-Z
Property Tax ID#: �7 ��/ " 5-01- 000F -000 ' Lot No.
Site Plan Name: /SOIL./ ��7F Block No.
Project Name: N 0• /0T 6
Setbacks Front Back: Right Side: Left Side:
YD'E�TA1(LE�DE�RSYCf�RIP� fON OF 1h!®R, y p
�. a,
Com le W /��;on 6Y� � /�D� s ..�n01�,/ �o�P
/ era �ein¢vu rl y`
CON�STRUCTIOIV,INFORMATION µ, a k }
Additional work to
❑ e—e orme under this permit-c ec W a _appy:
HVAC be
Tank [:]Gas Piping Shutters ❑Windo.0w
s/Doors
Electric ❑ Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: ]Q S . FtFtt.of First Floor: 73 0
Cost of Construction:$ /700•oa Utilities: I��ISewer OSeptic Building Height: 911r1 t
z�mx.�4.`"'"''a vs.•xr. re , ^ ��1� ^'a ��:� z�,x'ys wk � ';" ,ad.� 5 °�S ,*.. � "�.':-a; ro 3�� -�^� a -,. x
®WNE�R/LES�SEf ,: r t - C®NTRA1CTOR �� � .�g
.."M .c'..'-...
Name 194X 49 6`- i&/!! L wW Name: A114,P77 5,^j-AA
Address: )-701/;::(/;/7/04 Ave. Company:XW41M ;,1`700%1 Oi6ail- 521e-
City:
2City: Aa4A'el State:.a Address: jfD oee. 17
Zip Code: X1/0 Fax: City: J2/l re'n ge eu ,_ State: .
Phone No:_ /,`) ' � ' /7� Zip Code: 31,96-7 Fax: 77-2-2-3)
E-Mail: Phone No. -;7 - 02 Uj0 .31716-
Fill
71 'Fill in fee simple Title Holder on next page(if different E-Mail: a im. /1 440 - eam
from the Owner listed above) State or County License: CRC /,25-/%X/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
U,PLEMENT�AL C®NS�T,�R, tJCTI®fil L.I!EN LAW I,NFOR�MATIO.N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGEyCOMPANY: _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 thepermit 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 ordin otice of Commencement.
s
_Signature of Owner/Lessee/Agent Signaturee tractor/License Holder
STATE OF FLORTO^ D STATE OF COUNTY OF O V
COUNTY OF IY�t� (�T�
The fogI�oing instru nt was acknowledged before me The forgoing instrumen as acknowledged before me
this fog
of 20 1 Lby this J4ay of 20 by
(Name of person ckn wledging) (Name of person ackno dgin )
(Signatureo otary Public-State of Florida) (Signature of Not y Public-State of Florida)
Personally own OR Pr duced Identification X Personally Known OR PrpdlIdentification
Type of Identification Produced � ,4 ,.e Type of Identification Produced"f(r�t��(o� IL�wP�.��,` Nc
Commission No. C&AE EDLUND-CHEN Commission No. Y (�� �NE EDLUND-CHE
,%RY,9,
NOTARY PUBLIC o� NOTARY PUBLIC
-w-TA EeFFLeRIIW
Comm#EE209993w Comm#EE209993
Revised 07/15/2014 ' ✓0l Jy.Jt; Expires 6/20/2016 � Expires 6/20/2016
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
.DATE
COMPLETE
INITIALS