HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` U
Date: �i �� Permit Number:
RECER'rD JUL 1 �Il7o
�. .. -
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 x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: D000 C':7� Oc.*nl !D./ 2A:;5-
Legal Description: /vt I M WV►T Zvi n Pao t2o- 1A/
CCLAAMW 32 -S(Z
Property Tax ID#: H$^OZ - 70 1 - 0003 - OL-Y,--)-1 Lot No.
Site Plan Name: 0rVAr1v4 Block No.
Project Name: 'Fj'AV A-NA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:"
Wt►� � f ar,+`-wt 2 o �I ti� COEX15 I.T AJ4
f, p
CONSTRUCTION`INF.ORMATIO;N:"
Additional work to be ertormed under this permit-check all appy:
11HVAC Gas Tank OGas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers FIGenerator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ( q 2 r Utilities."n Sewer 0Septic Building Height:
OWNER%LESSEE CONTRACTOR:
Name _TR If A NA CE-�h? Name:
Address: lo00-1, cS 0GEY1r.► `2f&4 Jt: Company:7IimKALA At f 1 M
City: 7EpvSE� State: ri_ Address: N(iJ N W`f
Zip Code: &4 Q S-7 Fax: City: S-J Avt j State
Phone No. (062) 16, — ZS'So Zip Code: 7!4-q Fax: 692 --5I 7 if y
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: IM,C- Gy4_ 7
from the Owner listed above) State or County License: rCz_ au2 c.( '��
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
51,PPLEMENTAL CONSTRUCTION LIEN tA1N 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
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 thepermit 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:Yo failu ecord a Notice of Commencement may resuV
r p g twice for
improvements o your pr er otice of Commencement must be rVdpt the jobsite
before the f' s ins cti . I tend to obtain financing, consul tth ey before
commen ' o or r cor our Notice of Commencement.
s
_si nature of Owner/Lesse Signature of ContractorfLiceny7Holder
STATE OF FLORIDA C-� STATE OF FLORIDA
COUNTY OF r "�Ul'l� COUNTY OF G7-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this/9�Ny of v4 20//,-by this/of �1�C� -y ,20 11,o by
(game-of person acknowledging) (Name of person acknowledging)
(Sign at otary Puublic-State of Florida) (Signatu -Notary Pu/blic=-State of'I:"iorida)
Personally Known v/ OR Produced Identification Personally Known t/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. „-- Seal
�ait;:Y?!!¢•., ANN M.GAUMOND =Q4AM1'!?YB4.,,, ANN M.GAUMOND
'+= MY COMMISSION#FF 173907
p'• EXPIRES:December 7,2018
Q •, as EXPIRES:December 7,2018
Bonded Thru Nota Public Underwriters o?•`'
Revised 07/15/2014 ,• 4F'"��" Notary
'•'�.,,q°�tk`` BondedThruNotary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS