HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFq MLIT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I` Permit Number:
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 X Residential
PERMIT APPLICATION FOR: Tserormdfepbox-dxk-arrow-a#the-end-of-line--,
PROPOSED IIVIPROVEME,NT LOCAT[ON
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Address: g LiS d S OGr �I �1'� ct I fiEN� I �Et-�
Legal Description: pCeh-v 7pu erZ5, cyVj0 - l//ViT 9'13 #AQ 0401 V S
CDM/K dy f-yyrI (OP, 7JI7 76 )
Property Tax ID#: 3S:35-- ?tom I —OUXo S - coo - 10531 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front l Back: Right Side: Left Side: NI
DNETAILED DESCRIPTION OF{WORK ������ I
{
0�IA
CONSTRUCTION INFORMATION '
Additional work toe nertormed under this permit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers 0 Generator _Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 5175 ` Utilities:In Sewer Septic Building Height:
OU�/NER/LESSEE .CONTRACTOR
Name rt«WN L Name: , l A(C44 = i
Address: QCompany:�r 3E SW- 136 4 .UW fJtAlM
City: t✓� State:�i Address: ��� Nk� X&
Zip Code: 3LIQio Fax: City: ✓tom State:
Phone No. �'( l Zip Code: SLi evq Fax: Z —n'17q L-(
E-Mail: Phone No. ! Z
Fill in fee simple Title Holder on next page(if different E-Mail: /Lt(G/fi9�7�L6�x�C�l�✓i�- yam'
from the Owner listed above) State or County License: �G 1�0 �J L4 3
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENL CONSTRUCTIOWIIEN LAW INFORMATION w:
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 thepermit 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/anotheron-residential use
WARNING TO OWNER:Your fail re o Record a Notice of Commencement may resa ' g twice for
improvements to your pr p otice of Commencement must recordee n the jobsite
before the first inspect f o intend to obtain financing, cot��
It len et rney before
comme in rk r r I our Notice of Commencemen
6,/Z 4411 'ArAy p,,T'lQVre.
/ s
ignature of Owner/ essee/Agent Signatu a of Contractor/Li ense Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF j/LOc/'�' COUNTY OFST 41JC_1_,r
The for o'ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
th�ay of �U�t)G 201�by thim `ay of _J'1>iC� 20 Z
Z,by
(Name of person acknowledging) (Name of person acknowledging)
(Signat of Notary Pub' -State o�Flohda) (Signa Notary iic-Sta e o "Florida)
Personally Known OR Produced Identification Personally Known I/,"— OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. M500AUMOND Commission No. & ANN M.GAUMOND
MY COMMISSION#FF 173907 _g`• "__ MY COMMISSION#O 173907
EXPIRES:December 7,2018 =
•.,of boruled Thru Notary Public Underwriters %?'• P,. HIS
?f F°,• Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS