HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p ^
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Buiiding and Code Regulation Division
2300 Virginia Averue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: S e !` %1`s'tri T5 1(ICA S F` 3`f�
Legal Description: iuUA 4,S- 131 k 0 L 6
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Property Tax ID#: 3 1 J 'J '/o Z l;Z-6 00 Lot No.
Site Plan Name: Block No. 571/)
Project Name: 2 i ver lAa:rk
Setbacks Frunl Rack: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CA^ 1/ �'.e
CONSTRUCTION"INFORMATION:
ition r to6eperfbrmed under this permit-check all that appy:
HVAC _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric. _Plumbing _Sprinklers _Generator _Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor: 16 T
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Cost of Construction:$ 3/ Utilities: _Sewer _Septic Building Hei r.1''7r.J1-
OWNERJLESSEU CONTRACTOR:
Name / Name:
Address: 14� � ar/K ex V4 4a fi 1 o Company: J e41M d'T-i
city:_k State: Z- Address Z IA1
Zip 01(le: _'TV!C 2.3 Fax: Gly: i I-14cx Stale=��.
Phone No. Z lf- $ Zip Code:S�O Z 3 ""'Fax-
[-Mail: dJ_1 t l/PI e-,/l-l-I1r_ iii 4tC), •Jlz Phone No. ^ T-2Sr- e i I
Fill In fee simple Title Holder on next page(If different E-Mail: 00,
from the Owner listed above) State or C my License:GR46- )Z J-0 J9 2
If value of construction is$2500 or more,a RECORDED Notice ofCo ncement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION
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: PC- a,r- 9 iv/&t¢�Lt Name:
Address:_l(7 t y ?6 s'f, 1+P+J0 Address:
City: City:
Zip: Phone: —3 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 apermit will authorize the permit holder to build the subject structure
which is in corrt+ict 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 rnn-Idpration of the granting nfthK requp---ted permit,I do hereby agree that I will,In all rpsppct-,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 slruclures,swimming pools,fences,walls,signs,screen rounis and accessory uses Lo dnulher nun-residell Lid[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 recordinp your Notice of Commencement.
101
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L�,��SCOUNTY OF
�
The ng instrun c+e:t was acknowled d fore me The fnrgning Instrument was arknnwledgpd hPfore me
thin% day of 2016y his_ddy of 20 _by
(Name of person acknowledging I (Name of person acknowledging)
ay\4�ry��Aj
(Signature of Nota tihlir.-State of F nrlda) _ (Signature of Notary Public-State of Florida i
er on Ily no OR Produ d ificatione Personally Known OR Produced Identification
ype far pf" ANGEL Type of Identification Produced,-_-__...__ .....__.___......-..___-....-__...-
a r5 k p, Notary Public-State ot(Ro0da Commission No. (Seal)
•• r •- Commission#FF 234730
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1
y
hrou h National Notary y Assn.
Revised U7/1�/"?o+
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS