HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� tog
Date: Permit Number0s o V g—
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 Residential
PERMIT APPLICATION FOR; To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCATION:
Address:_, _S- O l
Legal Description: t262 L 1I)A\/;P//Y/X S-l)
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Property Tax[D#: ( 1360 QCYQ Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona !wor to (e na Orme under this permit-check a ply:
HVAC L=1 Gas Tank Gas Piping OGenerator
Shutters Windows/Doors
Electric FlPlumbing 05prinklers Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
450
Cost of Construction:$ ,� Z-4 o Utilities:0 Sewer a Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Namej,, ),960 Name: en sO> • I-00ZI-.41Yl3
Address: !/V10-S Company:
city: f r�Z/ rt State:eG. Address:-"3 Zsg-�.�,4 F ,eay-
Zip Code:i IF-3 Fax: City: f c2 e TST,L tscr iz State:
Phone N . 36:5- lf3 t— 122 zip Coder __ Fax:7-7.2.. 336 Lr3�9
E-Mail: Phone Nc ?7 2 2-6 -at,I 1
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 2!,'42.2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: A`
&92J=—VeC14 Xc Name:
Address: /,/,:: o Z-4wy s-4r,,7;0 q(, Address:
City: State: City*
, 4F-4�C14 — State:
Zip:-4104-2 Phone:.V5-4e 977.7 4-2 Zip: Phone:
FEE SIMPLE!TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: i Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that go work or installation has commenced prior to the issuance of a permit.
St.Lucie Coun:y makes no representation that is granting a permit will authorize the permit holder to build the subject structure
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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.
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The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory strbctures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
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'NARNING(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 thelfirst inspection. If you intend to obtain financing,consult with lender or an attorney before
commencinR work or rer
pording your Notice of Commencement
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Si nature of-0`wnTr-J—Lessee/Agent Sigdafure of donitr6cf6r/License Holder
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STATE OF FLORI A STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrum,ent was acknowledged before me
this d ay 20 Irby this -7 day of 61IJ 20 by
6�- d
(Name of person acknowledging)
(Name of person acknowledging)
-(Signature of Notary Publib-State of Florida (Signature of Notary Public--StAb of Florida
Personally known_OR Produced Identification Personally Known OR Produced Identification
77r-=Z� —
Type of Identification Produced Type of Identification Prq�jvg
y fiC""
Commission Na. (Sea[) Commission No.
"In", MyCam Public C-st'?I" AM
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Sanded Fc .20
07/15/2,,! AHNA
INGRAM 9
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Revised LASH thro
through 17?24
Nota Murida a]
otary
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xpi es Dec REVIEWS; FRONf"-'%;�'�Ilil` k9oiqFaGission 46,y PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER gh Na iona REVIEW REVIEW REVIEW REVIEW
DATE -4)
COMPLETE