HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABBL INr MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / �11M 0 A&it Number:
Ilk
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 Y— Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
. .� �.. a .,
PRORO,SED IMPRO.VEMENT.LOCATI( N
Address: �"7�O S O ce7,Y4Q .93q
Legal Description: JSC.A-qn/FS Co/VOa 13Y A- 4-
449A4 I4, -t_ Go ivo 0 -7 l ^ /v Y R
Property Tax ID#: '''.`` 35-35= 601 -C)o`/` —6W- I Lot No.
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Site Plan Name: l t►c.i ArM-S61%) , Block No.
Project Name: W►L.-t-t S C1"
Setbacks Front Z Back: Right Side: Left Sid
DETAILED DE,k TI1 OF WORK j
CO.N�TRUCT( }N.IN`FORNIATION
_, _ . . .-
Additional wor toe e orme under this permit-check a appy:
11HVAC Ei Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 2 �- Utilities: Sewer Septic Building Height:
0,,1NNERjLESSEE CONTRACTOR . .
Name �.. A'/V Name: !G/ t.✓/
Address: 07 5 9 Company: 'rF�O✓ G1iZ+ iiyc�n
City: _�)b FAi Ealr,1-L State: TL Address: 117-8
Zip Code: ,3 f9 C
Fax: City: ,54x/AlllState:
Phone No. X0114 893' S Zip Code: Afly Fax: 44 -7
E-Mail: L/1A1114_ 150 ar/RA/G-1G� Phone No. f 2- 00 c)
Fill in fee simple Title Holder on next page (if different E-Mail:NIC -� /_zo/Yi✓/� o,C&2
from the Owner listed above) State or County License: e!!]< c-_ _( --j--
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
`1ED 'AAY G a
SIIPPLEMENTAI CC►NSTRt1CTIN LIEN LAW INFORM,41'ION
,:.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: —fP "owSILI Name:
Address: Address:
City: State: P.- City: State:
Zip: I'I Phon 2 -a2 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 pro ty Notice of Commencement must be recorded and posted the jobsite
before the first in cti y intend to obtain financing, consult with le der or n tto ey before
comm i wor ore di our Notice of Commencement.
s
Si ture of Owner/ gseAgent Signat re of Contract ense Holder
STATE OF FLORIDA STATE OF FLORIDA 1+
COUNTY OF T-/luCOUNTY OF �/,
The f rgoing instrumen was acknowledged before me The forgoing instrume as acknowledged before me
this day of p�![ 20 )&by thisday of pQ< < 20 1& by
(Name o per cknowledging) (Name o son owled 'ng)
(Signatu a of Notary Publi State of Flori (Signature of otary Public- tate of Florida
PersonalI Known OR Produced Idents ication rsonally Know OR Produced Idents n
e o entification Pr Type ation Produced
�� / �{�""""'''•. JOHN LEE TINNEY ,�u
`� ommission No. '�� JOHgieBHINNEY
Commission No. n, NoE �blic-State of Florida :'2. �: Notary Public-State of Florida
My COMM.Expires Nov 15,201 ': M Comm.Exoi
.� o.•
%.,���;,..•• Commission#FF 165316
Bonded through National Notary Assn. °FOP F`°p��, Bonded through National Notary 653 Assn.
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS