HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( D,
Date: Permit Number:
0
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 _K__ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.'INIPROVEIVIENT.LO:CATIQN
Address: 9-75-o OWN' ( Vti � SKN a),e V_t
Legal Description:_95-3-5- OWN'-601 -DOZ (:v -C)CPj -'0
15 c.Ary d 0 JrJ(:.S Cor')IOD A div rT /5-3q A-141A .L42944112492 etlV rJy
Property Tax ID#: 35'3s`6 cp i, - 00-7(o Lot No.
Site Plan Name: �An�f� A�( Block No.
Project Name:_ W r
Setbacks Front Back: N Right Side: Left Side: �-
DETAILED DESCRIPTION OF WORK flk
20i;VlrwC'
CONSTRUCTION INFORMATION
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Additional work toe e orme under this permit-check a appy:
HVAC Ei Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator F] Roof
Total Sq. Ft of Construction: �/, S . Ft.of First Floor: ^//4-
Cost of Construction:$ /0179-0 Utilities: _Sewer Septic Building Height:
QWNERAESSEE CONTRACTOR:
Name 0 Albljlq4. Name: > c 'LjdW i
Address: /G A- Company: Ch1 UV�tow�M
City: /t/t D fGC .eUM N L' iZ•[_ State:j�A Address: I'?2D ps(,� E}? tLkvjy
Zip Code: Fax: City: SkUf►?rr St ate
Phone No. ��� -- 3faD,�3` Zip Code: ��(�'� Fax: �/2 714Y
E-Mail: 'jF L3 )y�l) 0, �yTb�'A'rC a C a� Phone Na
Fill in fee simple Title Holder on next page(if different . E-Mail: !i✓�/v
from the Owner listed above) State or County License:ti-TC (70944,372
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFRMA1'IQNw
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 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 properZntend
otic e of Commencement must be recorded and o ted on the j site
before the first insp ct' If to obtain financing, consult with I d r n ttorney before
comm cin wor r e n Notice of Commenceme
s
'Signature of Owner Lessee/Agent Signature of Contrac r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S7- 4()G/ COUNTY OF n i I UC.I,C
The forgoi g instrument was acknowledged before me The forgo' g instrument was acknowledged before me
thi& - "'ay of �1 C�.(�� 20/�by this. y of ,1 C��� 20/�by
(Name ofperson acknowledging (Name of person acknowledging)
(Signator of Notary Puub t =State o orida) (Signature ary Puat
blic- e-of rida)
Personally Known ✓ OR Produced Identification Personally Known 1'/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
ANN M.GAUMOND ANN M.GAUMOND
MY COMMISSION#FF 173907 =t4 ':= MY COMMISSION#FF 173907
ecem er 7,2018 ecember 7,2018
cP` pf'°:`' Bonded Thru Nota Public Underwriters
Revised 07/15/201
"' Bonded Thru Notary Public Underwriters „q • Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS