HomeMy WebLinkAboutApplication (2) ' ,t91A.L APPLICABLE{NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED }
Date:_ Permit Number: _ _ 0l
Building Permit Application
Planning and Development Services
Building and Code Regulation Division -
2300 Virginia Avenue, Fort Pierce ft 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR; To Select from dropbox, click arrow at the end of line
Address: 3113 347'7 -ytDp 1 (_e, 166 _
Legal Description:
Property Tax ID#: .3��5 �� - O / �}G� - OoO - 2 Lot No.
Site Plan Name: Block No. 4/1
Project Name: M01—a ti Aee 5! 7C-2_
Setbacks front Back: Right Side: Left Side:
4
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AcIdItIonal work to be nertormed under this permit-c ec a
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app y:
HVAC Gas Tank oGa
s Piping Shutters I__�1 'ndows/Doors
Electric i=1 Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction:_ �3 c2 t/Y Sq. Ft. of First Floor: 22
Cost of Construction: $ - &iGa Utilities:Sewer Septic Building Height:
7m777_
e: 5 .�-6 pany: i' l7 ter Address: D ' . f
Zip Code: Fax: City: L Stater
Phone NkIVILkv - is- Zip Cade; 3L S2 Fax.3�.�`-
E-Mail:_ Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: �. ✓/S •t
from the Owner listed above) State or County License; Cc(-� ���m�
If value of construction is$M00 or more,a RECORDED Notice of Commencement is required.
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.LucieCo un makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in tr ct with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
c 0 n li
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 recorging your Notice of Commencement.
s
Signature of Owner/LeS5ee/Qent Signature of Contractor/Li rise Holder
STATE OF FLORIQ# STATE OF FLORIDA .
COUNTY OF COUNTY OF (St
The f r Ing instrumenLwas acknowledged before me The for4ging instrument was acknowledged before me
this day -TIA I ci 20 tLby this gr day of 20 Jl::;, by
PA o f_
6 glg�i "S.
(Name of person acknowledging u (Name of person acknowledging) V
7Signatbfe of Notary Public-State of Florida (Signature of Notary Public-State of Florida
Personally Known V/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identifi
N pw��7 Nftry Public Sate(of FWft
Commission No. Notoy of FkxWa Commission No Jonn*t Delft (Seal)
JunrOmw Da my ummft FF 956029
My C"am"Ion FF 9W29 Expir"02r2*2020
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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