HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEINF MUST B COMPLETED F.0,11 APPLICATION TO BE ACCEPTED
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Date:.:: Permit Number:
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Building Permit Application
Planning and.DeveiopmentServices
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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Address: �4QV ICO I J V RiC`l�P 61 V-01 --44-2- P i+U I Fl- 34q 9Q
. Legal Description:_RiV&SfCle 1!I l lh6t Unit 4-2-
Property
-2Property Tax ID#: 4L/2-6 JSK1"002Co - C00-q- Lot No.
Site Plan Name: -4 NC���'X?}. Y R 1 Q . Block No.
Project Name:_ hdoliun Desi ' en
Setbacks Front Back: Right Side: Left Side:
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Remove 4- replo,6-e windGwS -f- ckxors Uj►+h i PnpaC-{- .
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Additional work to be Y Derformed under this permit-Check all t=appy:
HVAC E Gas Tank Gas Piping _Shutters indows/Doors
FlElectric Plumbing OSprinklers F]Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ L'7,WO.OD Utilities: []Septic Building Height:
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Name 11Qi,o},nnh-�1 0-10 CJ1Ul"i Name: J GgPyCde
Address: 341.51 (NC�',r ield Club 0L Company:_-The (�)Q�S PiC3112SS10)11Q.15
City: t1Ia nC i e...1 d -1-1 i i is State:_HT- Address: 223610 SE T) i e 4-IVid
Zip Code: 4S,9n1 Fax: n 10. City: State:i-]_
Phone No. Zip Code: 3-1-99_7 Fax: 77-_�-X86-04(01
E-Mail: 1(1rr1j QQJdC'jClrli.tY1 . i'iel< Phone No. -7,)-- 2-3(D-04 5 c1i
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County.Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wVVor recor($ing ypur Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of CoKtraUQdVcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF M61rh
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of jj k4 20"13p__by this 54t day of 20 Ili by
(Name of person acknowledging) (Name of person acknowledging)
OD�n,t irvur-�
(Signat&e of Notary Public-State of Florida) '/ (Signatu of Notary Public-State of Florida)
Personally Known OR Produced Identificati n P rsonally Known OR Produced Identification-
Type
Type of Identification Produce a of Identification,
�.,,���u,,,---ICEttf iM
gr Pr,
;•_�• ,C- Notary Public-state of Florida Notary Pu¢�c-$,tate of Florida
Commission No.F as �� = ;.:(Se�)nmission # FF 929255 mmission No. ;:• - s FF 929255
Commi
My Comm.Expires Oct 20,2119 FGacja-S-T u;• ��=c My Comm.Expires Oct 20.2019
OF F� National Notar A sn. p n
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS