HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB NF MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
.!-.-M- Mi
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 (IMPROVEMENT- LOCATION: 'p
Address: O a 0 G C a�� �� L 3 j b
Legal Description: kr6 e~r `CtAsig- ! Plci- Itor SM
—713)
Property Tax ID li: qq 2Z ' 01 S'' 0 007 - boo - q Lot No. T
Site Plan Name: "du r ��c��c. ��4�' PC) 21 A Block No.
Project Name: _70we'r �PiW10�i�i ova
Setbacks Front 35 Back:3 S Right Side: Left Side: •�
DETAILED DESCRIPTION DF WORK:.
�ew►b(:4: avj rewtamt 6F 4` rt, &:K it k wtl/ ��� s�°i'I I�OoI e� a,11 Iv►+Or�'°r
-f6er$o� f k4gX^w3�t.l � rriv�(.0 y.c 11) 4e, ey4er cw- W&1( a'(' �tl
wu►t�tr i �rr�,., 16� 4 c. erw4�c fvrc,� o r, Oke r',eiLr o F 4�4 bow,,.
CONSiTRUCTION'INFORMATION:
A00itional wor oorme under is perms -check a appy:
HVAC DGasTank as Piping _Shutters Windows/Doors
11 Electric a Plumbing Sprinklers 0 Generator Roof
Total Sq.Ft of Construction/: PLA A S .Ft.of First Floor: W
Cost of Construction:$ / '� �I ltilitiesUSewer Septic Building Height:
AWN€R/LESSEE:. CONTRACTOR:
Name 't' 4 M 4--_ ?owcrc. Name: &VM •r
Addr s: 6b M W wi cr ` . Company: C`or rycAi-
City: � V, State: EL. Address: 3 W � a v�
Zip Code: 3411 Of Fax: City: %V&C}' State:--
Phone No. Z03- 1S1 • Sk S 3 Zip Code: 3q qg Fax: 77.1':2gl- $ $or
E-Mail: Q Cal I Phone No.'7 -? Soo
Fill In fee simple Title Holde on next page-(i different E-Mail: ;M it,aL fi GIl h 2
from the Owner listed above) State or County License: d'A
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL,CONSTRUCTION�IUEN.LAW INFORMATION:
DESIGN ER/ENGINEER: ZNot Applicable MORTGAGE COMPANY: �l Not Applicable
Name: Name: 7"�
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 Assocration 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.
s
Si nature of Owner/Lessee/Agent Signature of Contra r/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF �i COUNTY OF glXlrCL
The foriging instr ent was acknowledged before me The forg 'ng instru ent was acknowledged before me
this�day of 20,(�by this,?ay of 2014 by
r 6,cr v� L• NC 0.Was ���Ade
( ame of person acknowledging) (Nacre ofp_erson acknowledging)
(SIgnature of Nota ublic-S to of Florida} 11( g�nature of Notary Public- tate of Flo a)
Personally Known X OR Produced Identification Personally Known x OR Produced Identification
Type of Identification P oduced Type of Identification Produced
. KAiHE MCCOMAS
Commission No. �= ¢ Commission No. �: KATHERrflaN} MCCOMAS
�, o-, CommC §�5 fi M FF 900595 pp - Commi§sion#FF 980595
9� ?� �� My Commission Expires ��-9py f,. My Commission Expires
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RIF
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS