HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IIV.0 MUT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: h2DS=� gg _ca
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-- 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
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Address: zyq t \,,:,-cn � Ft V` rC� Ft- 3H y,L4U
Legal Description:
Property Tax ID#: ( 14 I • 0010 Lot No.
Site Plan Name: Block No.
Project Name:U- rQ %-A
Setbacks Front Back: Right Side: ':,Left Side:
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itiona war to e e orme 'un er t is permit-c ec a appy:
HVAC �,Gas Tank ❑Gas Piping _Shutters Windows/Do�ys�
aElectric Plumbing ❑Sprinklers Generator Roof
Total 5q.Ft of Construction: S Ft.o�First Floor:
Cost of Construction:$ �io(� Utilities: Sewer Septic Building Height:
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Name obcrt U Name: ,�y������17c�,U`�,y= tia<iS1fr-
Address: V Company_':Jzl cn QC�P�fi]���
City: rt P Ciz Stater Address:
Zip Code: )H q H(0 Fax: City: eC-A C State:-F—'--
Phone No.�1 Q I- UQ )?'— $5 Zip Code:33i1 1 a-- Fax: 5-61 -1sS .elf)5-9
E-Mail: Phone No. J`�L�s/- ��A , OS'a
Fill in fee simple Title Holder on next page(if different E-Mail: f?
from the Owner listed above) State or County License: L�o l_ 0 kc�L-FS 3 t
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
OWN,!; N'll", I WEIN
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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,autfiorize 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 Horne Owners Association and review your deed for any restrictions which-may-apply.
Inconsideration 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-'a-n '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 bi recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consultwith lender or an attorney before
commencing work or recording our Notice of Commencement.
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�`� nature.of Contractor/License Holder
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STATE OF FLOP
, STATE OF FLOR
COUNTY OF A
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The o oing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 4by this g day of Jowe ,20 by
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(Name of person acknowledging) (Name of person acknowledging)
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Ignature=of:NotaryP-util cTState of Florida) (Signature Nota P'ublicc--Stat f Florida)
Personally Known `�O oduceda of Personally Knowny OR Produced Identification
Type of Identification Prod ce u Type of Identification Produced
o`� Notary Public,State of Florida �o'�Ayp s�,c ,�aNc� YOUNG
Commission No.v ( di)nission#FF 170156 Commission No. * MY c ION#FF 951069
t,�offlM,QV;l1C8 Oct.20,201 B N�� 'e`dTEXPIRES:April 12,2020
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS