HomeMy WebLinkAboutBuilding Permit Application i I
t ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! • 7.z ti Permit Number: AD V
RECEIVE®
•
Building Permit Application JUL ® 7 1016
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: . r k 0 �(-'4 y
Legal Description: /35-J37 w A C,r- 66G.S"j A-,r� S Q T' bL YV Ya 6,c
.S'w Y� o A'-' f -I '+ S L--
Property Tax ID#: a3o 13330 001- 0 0 0 -- Lot No.� /
Site Plan Name: N1p' Block No.
Project Name: t)_).AALDU n' olTlbN
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION Of WORK r' '
Y'-10 L&f '
CONSTRUCTION INFORMATION 1. r
Additional work toe performed under this permit-c ec a appy:
E1HVAC 11 Gas Tank 0Gas PipingOGenerator
Shutters E]Windows/Doors
Electric ElPlumbingSprinklers Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ p Utilities: Sewer ElSeptic Building Height:
.'OWNER LE55EE LL TR
41
41
NameA L c9 �'(io PE 2T/�S L C Name TEVg: vty�
Address: JUS A)- fZ)AV_CI S.'0 S Aub S Company:V_:&73��''n 4F 0E-pd",�--Uc
City: w-Es,c- PA`rn t;CPc-4 State: F L Address: 10 1 I .'CPC.►Ay �✓Zl(/c
Zip Code: 3 D Fax: City: T&L-i A Fm.0 e., State:
Phone No. Zip Code: `Z 9 S'y Fax:
E-Mail: Phone No. 772 -3Lt Z4__7 /O o
Fill in fee simple Title Holder on next page(if different E-Mail: a Q 0— 'C D'
from the owner listed above) State or County License: C 6 C ► S o 5`4 9 d
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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LAW
SUPPLEMENTAL CONSTRUCTION LIEN, INFORMATION:
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
Na me: 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 property.A Notice of Commencement must be recorded and posted on the jobsite
before the fi st inspection. If you intend to obtain financing, consult with lender or an attorney before
commenciDg work or, c2rcling your Notice
LL of Commencement.
r•
-o; •.Till- S
o. nature of Contractor License Holder
_ ignature of Owner/Lessee/Agent ,poA.��• .,Signature /
STATE OF FLORID LFi STATE OF FLORIDA �
COUNTY OF X� COUNTY OF (X LcCi`�
a 59-M
The for oing instr nt as acknowledged be OE m The forgoing instrument was acknowledged before me
this day of 20f�b d_ this 7 day of 7"� / 20 /6 by
�T S
a Nv S
de"O"'y er ��� v�
(Name of person acknowledging) (Name of per n acknowledging)
(Signature ofo ry Public-State of Flo a) (Signa re of Nota Public-State of Florida} /
Personally Known R d ced Ide tificatio / Personally Known OR Produced Identificationy
Type of identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. �� b 3 M MISSION#FF220131
1,'A CO :APR 13,2019
Cr Bonded through 1st State Insurance
Revised 07/15/2014.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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