HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to Permit Number:
NOR
Building Permit Application
Planning and Development Services _03 D/�
3
Building and Code Regulation Division v
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED-IMPROVEMENT LOCATION:
Address: 6, oce Op
Legal Description:
Property Tax ID#: -MA- /(3-0002 -6008 Lot No.
Site Plan Name: Block No.
Project Name:. Gc.�O �i1 l�Cutd vrio
T
Setbacks Front oB Back:315. 33 Right Side:la . dv Left Side: /05. 2 9
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nerformed under t ispermit-c ec a appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
OElectric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ J Utilities: _Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name J- //C�� Name: kc.c�v
Address: S'$O ���n.oLcom/ Chi Company:
City: State:_*14 Address: g,Y7 Ad
Zip Code;W982, Fax: City: ��a, o �l State:
Phone No.? 7-? -46 78- -.2,04, Cf' Zip Code: Ji/f V5 Fax1 -VG/- a-n
E-Mail: Phone No. ?7.?- 4611-.2777
Fill in fee simple Title Holder on next page(if different E-Mail:-alty[yDfi`de-.,ehir-4H 1'ea,L ,e oar,
from the Owner listed above) State or County License:_FC
SQL # G
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION -LIEN LAW INFORMATION:
DESIGNER/ENGINEER:••ll _Not Applicable MORTGAGE COMPANY: f _Not Applicable
Name: N I Name: N /�
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HO DER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: iK Ila
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 inspectio . If you intend to obtain financing, consult with le!nOtran attorney before
commencing work or re,46oringour Notice of Commencement.
A -7
U, a-,�_-,
/19& s
Sn t re of Owner/ ssee/Agent Signpre of Contrac r/License Holder
STATE OF FLORIDA STATE OF FLORIDA "
COUNTY OF GC GJ COUNTY OF
The for oing instrument was acknowledged before me The forgoing instr e
nt was acknowledged before me
this ay of _��Ne� 20�by this Wday of c'iV F� 20 by
(Name of l5erson acknowledging) (Name of erson acknowledging)
(Signature o Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produ�c Id tification Personally Known�OR Produced Identifi tion
Type of Identification Produced_ PV."_; � Type of Identificati n Pro, ed FAVE A M
FP���o�tea?5,,`i MI�'j10N4Ff
Commission No. oR py0'53'_b al) Commission No. * ipmes.-Au a V
_�,... I 014% ,y� opts gpnd¢dt1�N o��Y
de0. �EOFa
Revised 07/15 ' @1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS