HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
e
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)46271578 Commercial Residential
PERMIT APPLICATION FOR: Other
PROPOSED IMPROVEMENT=LOCATION:
Address: Ia4lN hAlzeey4 v
Legal Description: -re zzc &W_A
Property Tax ID#: 'Wa6 -5-/0 -L'0.2 e-Oco- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:- Left Side:
DETAILED. DESCrRI.PTIbN Q,F WORK
Ude. aYlV6* JbaJ11i'ool)ls :0
CONSTRUCTION.INFORMATION.
Additional workto e e orme un er t is permit-check a appy:
:0 HVAC []Gas Tank ElGas PipingShutters Windows/Doors
UOOGenerator
Electric Plumbing Sprinklers Roof
Total Sq. Ft of Construction: S ..Ft. of First Floor:
Cost.of Construction: $ AAA OR 200-(z UtilitiestSewer[]Septic Building Height:
QWNER/,LESSEE J-CONTRACTOR:
Name Cq 6 1,10 A Name:
Address: . Company: /n �`r�.uSfi'vcf�o�l. LLCM
-City: State*4 Address:
Zip Code: Fax: City: ?YU�1 State:.
Phone No. 4Z 4 a g--Z L2 Zip Code:Wt1ffiT_ Fax:
E-Mail: 1, Phone No. 77�7_ 79f &-06
Fill in fee sim " Titled older on next page( if different E-Mail: 9 ALJaDtJS(-e 0 Lf
from the Owner listed.above) State or County License:_CGe',,60749
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION IE,N tAW INFORMATION
DESIGN _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: 1 Address:
City:_cz:g1� State: c,• City: State:
Zip: ! Phone: 77,z 0.7—.5P 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 property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inssp�ection. If you intend to obtain financing, consult with lender or an attorney before
commencingcor v k recordin our Notice of Commencement.
_Signature of Owner/Lessee/Agent Signature of Contractor/L§tense Holder
STATE OF FLORIDA STATE OF FLOPqAZ_7-t1_J
COUNTY OF �YJy,r?�-i.tJ COUNTY OF
The fo ing instrument was acknowledged before me The forgo' g instrum nt was acknowledged before me
this ay of ( 20,/ by this j�f" ay of uL 20 1411_by
( ame of person acknowledging) (Na a of person acknowledging)
Q
( 'gnature of Notarpublic-Sta&of Florida) S.gnature of ota Public-St to of Flori )
Personally Known_ C OR Produced Identification Personally Known_�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.ZZA05_f6_ (Seal)
2o,, KATHERINE L, MCCOMAS
Commis ,�;:: ��,, KATHERINE L. MCCOM
":,•.,� ,��� My Commission Expires _, ,=
Commission
Revised 07/15/2014 April 1 0, 2020 My Commission Expires
April 1.0, 2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS