HomeMy WebLinkAboutBuilding Permit Application L
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /_ �1,
Date: Permit Number: K -&/qo
W3911 9A San=
Building Permit Application
Planning and Development Services it
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 III
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at thee nd ofline
PRO;P,OSED IMPROVEMENT LQCATION:
Address: 6 �) US -A- k if 0
Legal Description:
Property Tax ID#: ` zD- [L+I - CXDb`1- 111J_ 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED`DESCRIP..ThON OF WORK. '"
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CONSTRUCTION INFORMATION r j ,
Additionalwork to be nertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
WElectric 0 Plumbing Sprinklers Generator' Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ 100() Utilities: Sewer D Septic Building Height:
OWNER LESSEE �, CONTRACTOR:
Name LLC Name:
Address: Zbk Company: L
City: Q J Stater Address: (_ACy��dwaL4 1201
Zip Coder laLA Fax :
City: State
Phone No.-TrL- wz 1 es;�2 Zip Coder �Z Fax' 7-(4(
E-Mail: Phone No '__( .-4o�
Fill in fee simple Title Holder on next page(if different E-Mail: ��aaA c
from the Owner listed above) State or County License: A�k E)w
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.!
SU"RPLEMENTALCO:NSTRU�CTION LIEUTAW INFORMATION:. .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _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 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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_
Sign atuo wner/Lessee/Agent Signatu of Contractor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF c I C KS- COUNTY OF
The for in in u ent was acknowled a before me The fo�,r�ng� instrume t was acknowledged before me
thi ay of 20 by thi�y of 20J_Q0_by
(Name of person acknowledging) (Name of person acknow edging)
V 2VIAL= 4
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known X (
OR Produced Identification Personally Known /_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
��„���„
Om sion No. Z3 ,��".... ea� BRENDA MARTINEZ
Commission No. 3� �►�` NA BRENDA MART1 E •;_ Clary Public-State of FI da
_ Notary Public-State a Florida E Commission#FF 2315
Commission O FF
res May 31, 19
o YCOMM.Expires May 31.2019 ''f°; ° Bonded ihraiph N�lond Notary n.
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Revised 07/15/2014 -...;"" BnndedthrouphNstiorutlNOtaryAssn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS