HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEeg S BEMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U Permit Number:
!I
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�IMPROVE:MENT LOCATIO`IV' `� x fi
Address: �� 4SMK 30iZ6tzK9 C�dUJL1 '1A% S-,-?�-06 - - - -
Legal Description: 5 /�� A/L'i) /3 /f% /C 1—/y
Property Tax ID#: 33,Z2 " d6/%"4C0--Q Lot No.
Site Plan Name: 4)/'N1)1si/— Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:.
'3DETAILEDYDESCRIPTION OF WORK _ _ _ ��� � ` �;k�
�j i I.Silit44-11 k) 1g6et`f 1)1(W �Ci�Z1�iC`F�ici+= �KGt�I�
Y T 1
°CON?STRUCTLON INFORMATION E y k fY
t:.a...�.._..._.. .. _ .. ..... ��.....�..._,.._..max ..... ...A. - . y
A it onal work to benertormed under this permit—check al tbal appy:
IVI
HVAC Gas Tank ❑Gas Piping LAJ Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers M_Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ -27'16.m Utilities:Sewer 0Septic Building Height:
O1WN;ER/LES1SEE CO k y
f NTRACTOR fV': Y �
` t:
Name Name: ;%Itek)IF-
Addr s Company: i)AS/1-T(l-9RE S'fia V/1
City: Sts Address:I-N- ) -SES y7- -1uwE j A?l(/
Zip Code: Fax: City: IV66c- ,SOMb State:Fl
Phone NoM -414Gn
Zip Code: ,�i /1'� Fax: -��/5 3.�47
E-Mail- Phone No. 72 3300
Fill in fee simple Title Holder on next page (if different E-M ail:(-U.Sf61,irrSer'we el17o ft'rewly,)u(tk.l.cu/"'1
from the Owner listed above) State or County License: .,W37
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'
SOP
CONSTRUCTION LIEN LAW 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 a rney before
commencing work or resprdinj your Ngtice of Commencement.
s
Sign ure of Owner/ rssegent bignatLrre of Contractor/Lic I
nse
STATE OF FLORIDA /A- STATE OF FLORIDA PA�
COUNTY OF /01�- COUNTY OF
The forgoing instr n as acknowledged b ore me The forgoing instru t w s acknowledged before me
this ilt day of—..6 , 20 Xby this /O'day of i 20 It by
(Name of perso ern—owle _ (Name of pers n ed in_
l
(Signature of Notary Public- ate of Florida) (Signature of Notaryublic- a of Florida)
Personally Known fJR'.'P..raduced Idd tr1f1'c+ECi'odoK Personally Known n 'fication
Type of Identification Peti-a J%�WPublic-Slate of Florida Type of Identification Pr
_• My Comm. Expires Mar 7.2016 ~ n Notary public
's:� •+ tl ¢ MY Cor b State of Florida
C tl �J ion # EE 176869 Commission No. '"�' 8 fires
Commission No. F . ,.,:; Mar 7
Bond, ro gh National Notary Assn. o .,, ,`' Commission 2016
Bonded Throu #`E 176869
gh Nati
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS